Barriers to adherence to secondary prevention therapy in patients with
ischemic heart disease: A cross- sectional study of a Mexican reference
center
Abstract
Background and objectives: Inadequate adherence has been recognized as a
constant determinant in the overall burden of ischemic heart disease,
particularly in countries with higher income-health inequalities, such
as Mexico. The overall impression is that the lack of population-based
epidemiological data and low public awareness may account for this
problem. This study aimed to determine the level of adherence to
secondary cardiovascular prevention therapy in a tertiary hospital in
Mexico City and identify the barriers contributing to medication
nonadherence. Methods: A cross-sectional study was conducted in the
cardiology outpatient department between August 2018 and February 2020.
Participants were asked about socio-demographic data, the MMAS-4, and an
interview regarding reasons for nonadherence. Results: A total of 991
patients were included, with a median age of 65 (58,72) years old.
Inadequate adherence to treatment was reported by 70.3%, with
forgetfulness as the most frequent cause (55.4%). Patients on combined
pharmacological therapy with PCI or CABG were more adherent than those
on optimal medical therapy alone. A higher proportion of patients in the
inadequate group were in NYHA classes II and III. Low educational level
and the use of optimal medical treatment alone were predictors for poor
adherence. Conclusion: These findings provide an initial framework of
the current situation of adherence to secondary prevention therapy in
Mexico, highlighting the value of promoting national consensus on
medication adherence to move towards a population-based strategy to
reduce cardiovascular disease burden.