Adherence to Treatment of Cardiac Patients: Approaches to Assessment, Ways to Increase and Prognostic Value

Abstract

Adherence to treatment is understood as a complex model of the patient’s behavior in relation to their health, implemented in the degree of compliance of such behavior with respect to the recommendations received from the doctor regarding medications, self-control algorithms, diet and other lifestyle change measures. Adherence can be assessed by determining drug metabolites in body fluids (blood, urine) and using various questionnaires. At the same time, an important role in increasing adherence to therapy is assigned to the attending physician, without contact with which most patients make an independent decision to stop taking all or some of the prescribed drugs or to make an unreasonable correction of their dosages. Among the factors influencing the decrease in adherence to treatment of cardiac patients are the patient’s misunderstanding of their disease and the expected effects of therapy, fears of undesirable effects of therapy, a low level of motivation, a tendency towards forgetfulness and some others. Comorbidity and related polypharmacy also contribute to non-adherence, especially multiple drugs are prescribed simultaneously by various specialists — therapists, endocrinologists, urologists, neurologists, ophthalmologists. At the same time, there is a clear increase in undesirable consequences (repeated hospitalizations due to myocardial infarction and other cardiovascular events) in non-adherent patients 6 months after the previous coronary event and a significantly higher risk a year later. Increasing adherence to treatment is the task of medical workers, starting from the inpatient stage of treatment (clear recommendations noted in the discharge documents), followed by the support of outpatient doctors, explaining the need to take certain medications, and ending with monitoring the execution of medical prescriptions.