Illness perception, cardiovascular disease risk factors knowledge, medication knowledge, and adherence among post-myocardial infarction patients who completed phase 2 intensive cardiac rehabilitation program

Background

Cardiovascular disease (CVD) is the principal cause of death globally and in Malaysia. In Malaysia, a 4- to 6-week subacute cardiac rehabilitation following hospital discharge is available for individuals who have experienced a myocardial infarction (MI) and involves a multidisciplinary approach that includes physicians, pharmacists, and other health care professionals.

Aim

This study aimed to assess the illness perception, CVD risk factor knowledge, medication knowledge, and adherence among individuals who completed a phase 2 intensive cardiac rehabilitation program after post-MI and their associated parameters.

Method

This single-centre, prospective study recruited individuals who had had a MI and participated in a cardiac rehabilitation program at a tertiary hospital from 1 August 2019–31 May 2020 using convenience sampling. Primary endpoints included Brief Illness Perception Questionnaire (BIPQ) score, CVD risk factor score, medication knowledge score (assessed using the Dose, Frequency, Indication, and Method of Administration [DFIT] method), medication adherence (assessed using A Single Question [ASQ]), and hospital readmission within 30 days. Associations between these endpoints were analysed. Ethical approval was granted by the Medical Research and Ethics Committee, Ministry of Health Malaysia (Reference no: NMRR-19-1091-48 132) and the study conforms with Declaration of Helsinki. Informed consent was obtained from all participants via distribution of a patient information sheet to potential participants explaining their participation was voluntary and all data would be anonymised. Written consent forms were obtained from all participants prior to their completion of the questionnaire.

Results

Sixty-seven participants with a mean age (±standard deviation) of 53.8 (±8.4) years and predominantly male (n = 53, 79.1%) were recruited. The median BIPQ, CVD risk factor, and medication knowledge scores (interquartile range [IQR]) were 34 (IQR 29–39), 3 (IQR 2–4), and 87.5 (IQR 75.0–94.0), respectively. Most (n = 60, 89.6%) participants adhered to medications. Eleven (16.4%) participants had hospital readmission within 30 days. A higher BIPQ (p = 0.037) and medication knowledge scores (p = 0.046) were significantly associated with medication adherence.

Conclusion

Individuals who completed the intensive phase 2 cardiac rehabilitation program after a MI demonstrated moderate illness perception of their CVD and good medication knowledge, both of which were associated with medication adherence. However, their knowledge of CVD risk factors was suboptimal and required attention. To improve the overall outcomes, cardiac rehabilitation programs need to be re-strategised.