On the Problem of Differentiated Assessment of Treatment Adherence Among Patients Undergoing Coronary Artery Bypass Surgery

Low adherence to treatment of chronic diseases, in particular coronary heart disease, is noted as a circumstance leading to a negative outcome. The issue of assessing adherence to treatment remains unsolved, especially due to the necessity of taking into account a whole range of behavioral aspects (control of blood pressure, diet, recommended physical activity, etc.), not just adherence to pharmacotherapy, which is associated with the characteristics of the treatment of the disease. The study of patient’s behavior in the therapy process, as well as a differential assessment of his/her adherence to different kinds of treatment, is a complex task that must be faced by the multidisciplinary team managing the patient: the physician and the clinical psychologist. Thus, the aim of the study consisted in developing a specialized questionnaire for assessing the behavior associated with adherence to treatment among patients with cardiac pathology in the postoperative period. The questionnaire developed by the authors is provided in the appendix. A detailed analysis of the data obtained from a group of 103 patients suffering from coronary heart disease and undergoing coronary artery bypass surgery, using the above-mentioned 8-scale questionnaire, confirmed that all the studied behavioral aspects are significant for determining adherence to treatment. As a result of the factor analysis of the questionnaire parameters, three main factors were obtained, which can be used for a more differentiated description of patients’ behavior in the therapy process. These factors were labeled as “medical”, “physical condition”, and “bad habits”. The article illustrates a practical example of how a patient sample can be divided according to the above factors for further detailed study of their psychological and clinical characteristics.

1. World Health Organization: Cardiovascular diseases (CVDs). Fact sheet. 2017. Available at: https:// www.who.int/ru/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) (accessed: 02.05.2020).
2. Kuzmina N. M., Maximov N. I. Adherence to Medical Treatment in Patients who Have Experienced Acute Coronary Syndrome and Percutaneous Coronary Intervention. Kardiologiia, 2019, vol. 59, no. 1, pp. 36–38. (In Russian)
3. Larina V. N., Akhmatova F. D., Arakelov S. E., Mokhov A. E., Doronina I. M., Denisova N. N. Modern Strategies for Cardiac Rehabilitation After Myocardial Infarction and Percutaneous Coronary Intervention. Kardiologiya, 2020, vol. 60, no. 3, pp. 111–118. (In Russian)
4. Pignone M., Phillips C., Mulrow C. Use of Lipid Lowering Drugs for Primary Prevention of Coronary Heart Disease: Meta-analysis of Randomized Trials. BMJ, 2000, vol. 321 (7267), pp. 983–986.
5. Turnbull F., Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of different bloodpressure-lowering regimes on major cardiovascular events: results of prospectively-designed overviews of randomized trials. Lancet, 2003, vol. 362 (9395), pp. 1527–1535.
6. Neutel J. M., Smith D. H. Improving Patient Compliance: a Major Goal in the Management of Hypertension. J. Clin. Hipertenns (Greenwich) , 2003, vol. 5 (2), pp. 127–132.
7. Hamilton G. A. Measuring Adherence in a Hypertension Clinical Trial. Europ. J. Cardiovasc Nurs, 2003, vol. 2 (3), pp. 219–228.
8. DiMatteo M. R., Giordani P. J., Lepper H. S. et al. Patient Adherence and Medical Treatment Outcomes: a Meta-analysis. Med. Care, 2002, vol. 40 (9), pp. 794–811.
9. World Health Organization: Adherence to Long-term Therapies, Evidence for Action. Geneva, WHO, 2003.
10. Cramer J. A., Roy A., Burrell A. et al. Medication Compliance and Persistence: Terminology and Definitions. Value in Health, 2008, vol. 11 (1), pp. 44–47.
11. Fesenko E. V., Konovalov Ya. S., Aksenov D. V. et al. Modern Problems in Securing in Adherence of Older Patients with Cardiovascular Diseases to Pharmacotherapy. Nauchnye vedomosti Belgorodskogo gos. un-ta, 2011, no. 22 (117), issue 16/1, pp. 95–99. (In Russian)
12. Kalashnikova M. F., Bondareva I. B., Likhodej N. V. Commitment to the Treatment in 2nd Type Diabetes Mellitus: Definition of the Notion, Modern Methods of the Treatment Assessment by the Patients. Lechashchii vrach, 2015, no. 3, pp. 27–33. (In Russian)
13. Lloyd J. T., Maresh S., Powers C. A., Shrank W. H., Alley D. E. How Much Does Medication Nonadherence Cost the Medicare Fee-for-Service Program? Med. Care, 2019, vol. 57 (3), pp. 218–224.
14. Pogosova G. V., Koltunov I. E., Roslavtseva A. N. Compliance to Treatment of Arterial Hypertension and Ischemic Heart Disease — Key Condition of Lowering of Cardiovascular Mortality. Kardiologiia, 2007, vol. 47, no. 3, pp. 79–84. (In Russian)
15. Ho P. M., Magid D. J., Masoudi F. A. et al. Adherence to Cardioprotective Medications and Mortality Among Patients with Diabetes and Ischemic Heart Disease. BMC Cardiovascular Disorders, 2006, vol. 48, no. 6, pp. 2–9.
16. Konradi A. O., Polunicheva E. V. Lack of Adherence to the Treatment of Arterial Hypertension: Causes and Correction Methods. Arterial’naia gipertenziia, 2004, no. 3, pp. 137–143. (In Russian)
17. Schwartz Yu. G., Naumova E. A. Adherence of Patients to Treatment From the Perspective of Evidence- based Medicine. Dokazatel’naia meditsina, 2005, no. 3, pp. 120–125. (In Russian)
18. Marchena-Giráldez C., Calero-Elvira A., Galván-Domínguez N. La importancia de las instrucciones del psicólogo para favorecer la adhesión terapéutica. Clinica y Salud, 2013, vol. 24, pp. 55–65.
19. Mathes T., Jaschinski T., Pieper D. Adherence Influencing Factors — a Systematic Review of Systematic Reviews. Archives of Public Health [Electronic resource], 2014, vol. 72 (1). Available at: http://www. archpublic health.com/content/72/1/37 (accessed: 28.10.2019). https://doi.org/10.1186/2049-3258-72-37.
20. Lowry K. P., Dudley T. K., Oddone E. Z. et al. Intentional and Unintentional Non-adherence to Antihypertensive Medication. Annals of Pharmacotherapy, 2005, vol. 39 (7–8), pp. 1198–1203.
21. Molloy G. J., Messerli-Bürgy N., Hutton G. et al. Intentional and Unintentional Non-adherence to Medications Following an Acute Coronary Syndrome: a Longitudinal Study. Journal of Psychosomatic Research, 2014, vol. 76 (5), pp. 430–432.
22. Naumova E. A. Determining Factors and Methods to Improve Patient Adherence to the Treatment of Cardiovascular Diseases. Abstract of Doctoral Dissertation (Medicine) . Saratov, 2007. 42 p. (In Russian)
23. Conn V. S., Hafdahl A. R., Cooper P. S. et al. Interventions to Improve Medication Adherence Among Older Adults: Meta-analysis of Adherence Outcomes Among Randomized Controlled Trials. Gerontologist, 2009, vol. 49 (4), pp. 447–462.
24. Levy A. E., Huang C., Huang A., Ho P. M. Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System. Curr. Atheroscler Rep. , 2018, vol. 20 (1): 5. https://doi.org/10.1007/s11883-018-0707-0.
25. Shalnova S. A., Deev A. D. High-risk Patient Characteristics. Results of the OSCAR Study: Epidemiological Part. Cardiovascularnaia terapiia i profilaktika, 2006, vol. 5, no. 5, pp. 58–63. (In Russian)
26. Steiner J. F., Prochazka A. V. The Assessment of Refill Compliance Using Pharmacy Records: Methods, Validity, and Applications. J. Clin. Epidemiol, 1997, vol. 50 (1), pp. 105–116.
27. Claxton A. J., Cramer J. A., Pierce C. Medication Compliance: the Importance of the Dosing Regimen. Clin. Ther. , 2001, vol. 23, pp. 1296–1310.
28. Demchenko E. A. Optimization of Conservative Treatment of Angina Pectoris: the Role of Dynamic Observation and Patient Education. Doctoral Dissertation (Medicine) . St. Petersburg, 2006. (In Russian)
29. Hope C. J., Wu J., Tu W. et al. Association of Medication Adherence, Knowledge, and Skills with Emergency Department Visits by Adults 50 Years or Older with Congestive Heart Failure. Am. J. Health Syst. Pharm. , 2004, vol. 61 (19), pp. 2043–2049.
30. Jin J., Sklar G. E., Min Sen Oh V. et al. Factors Affecting Therapeutic Compliance: a Review From the Patient’s Perspective. Therapeutics and Clinical Risk Management, 2008, vol. 4 (1), pp. 269–286.
31. Fofanova T. V., Ageev F. T., Smirnova M. D. et al. National Questionnaire of Treatment Compliance: Testing and Application in Outpatient Practice. Systemnye gipertenzii, 2014, vol. 11, no. 2, pp. 13–16. (In Russian)
32. Morisky D. E., Green L. W., Levine D. M. Concurrent and Predictive Validity of a Self-reported Measure of Medication Adherence. Med. Care, 1986, vol. 24 (1), pp. 67–74.
33. Morisky D. E., Ang A., Krousel-Wood M. et al. Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. J. Clin. Hypertens (Greenwich) , 2008, vol. 10 (5), pp. 348–354.
34. Baena-Díez J. M., Gómez-Fernández C., Vilató-García M. et al. Registro del historial farmacoterapéutico de la historia clínica informatizada en pacientes con hipertensión arterial: un nuevo instrumento para valorar la adherencia terapéutica. Aten. Primaria, 2011, vol. 43 (7), pp. 336–342.
35. Iakovleva M., Shchelkova O., Lubinskaya E. et al. Adherence to Treatment After CABG in Terms of Patients’ Personality. SHS Web Conf, 2018, vol. 40, pp. 02011. https://doi.org/10.1051/shsconf/20184002011.