Value of self-reported medication adherence in patients with coronary heart disease
Original article
Gehi AK et al. (2007) Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease: the Heart and Soul Study. Arch Intern Med 167: 1798–1803 PubMed
Nonadherence to prescribed medications by patients with coronary heart disease (CHD) is associated with an increased incidence of adverse cardiovascular events, but it is not known whether self-reported nonadherence can identify patients at greatest risk of such events.
Gehi et al. enrolled 1,024 outpatients with documented stable CHD and assessed the value of a single question—"In the past month, how often did you take your medications as the doctor prescribed?"—to predict the risk of adverse cardiovascular events. Nonadherence was defined as taking medication as prescribed 
75% of the time. Annual follow-up telephone interviews of the patients or their proxy were conducted to identify adverse cardiovascular events (CHD-related death, myocardial infarction or stroke).
A total of 83 (8.2%) of the 1,015 patients included in the final analysis reported medication nonadherence, and 146 (14.4%) patients experienced adverse cardiovascular events during the mean follow-up time of 3.9 years (range 0.09–5.7 years); 8 patients dropped out of the study. A greater proportion of nonadherent than adherent individuals experienced adverse cardiovascular events (22.9% vs 13.7%; P = 0.03). After multivariate adjustment, the relative rate of cardiovascular events associated with nonadherence (hazard ratio [HR] 2.3, 95% CI 1.3–4.3; P = 0.006) was similar to those associated with diabetes mellitus (HR 2.1, 95% CI 1.4–3.2; P <0.001) and current smoking (HR 1.9, 95% CI 1.2–3.2; P = 0.009).
The authors conclude that a single-item measure of self-reported medication adherence could prove to be a simple method of identifying patients at increased risk of adverse cardiovascular events.
Contact the journal about this article
Subject areas under which this article appears: Angina and coronary artery disease
