Factors influencing adherence to risk factor modification in patients with coronary heart disease

University dissertation from Kardiologiska kliniken, Universitetssjukhuset MAS. Institutionen för kliniska vetenskaper. Medicinska fakulteten. Lunds Universitet

Abstract: Adherence to lifestyle modification and pharmacological treatment is of great importance in order to achieve maximum benefits of preventive measures after a cardiac event. Unfortunately, patients are neither adopting adequate lifestyle changes nor do they adhere to prescribed medication. Consequently, implementation of CHD guidelines is less than optimal in clinical practice. The general aim of this thesis was to determine whether there existed a correlation between general and specific knowledge of CV risk factors and adherence to lifestyle modifications and pharmacological treatment. Furthermore, to determine demographic and situational factors, which could improve knowledge and adherence to secondary prevention actions in patients with CHD. Consecutive medical records of men and women (n=509) < 71 years of age hospitalised for a cardiac event were screened, using a cross-sectional design. Patients (n=392) were interviewed, examined and received a questionnaire, totally completed by 347. Findings in paper I showed that general knowledge regarding CV risk factors was significantly correlated to self-reported adherence in five of eight domains of lifestyle changes and attainment of treatment goals; weight, physical activity, stress management, dietary changes and attainment of lipid levels goals. General knowledge was also positively correlated to the likelihood of taking prescribed antihypertensive agents. Results in paper II demonstrated a higher significant correlation in all eight domains between specific knowledge and self-reported lifestyle changes, the ability to reach treatment goals as well as adherence to prescribed lipid lowering, oral glycemic and antihypertensive agents. Paper III showed that growing age was significantly correlated to a decrease of specific knowledge, adherence to lifestyle modifications and attainment of treatment goals in some domains. Females and patients with lower education level reached specified treatment targets less frequently. Regardless of sex and age patients did not reach treatment goals with respect to systolic blood pressure, weight or smoking, and 46 % of the study population had a plasma glucose > 6.1 mmol/L. Paper IV showed that specific knowledge, adherence to lifestyle advice and prescribed medication as well as the ability to reach defined treatment goals had no significant correlation to the self-reported HRQoL. Angina pectoris had an influence on HRQoL with the highest degree displayed in patients who classified their angin pectoris as CCS class 0. This thesis shows that patients? who reported a high specificknowledge adhered better to lifestyle modifications and pharmacological treatment. General knowledge is important in some areas of secondary prevention actions. Most benefits of higher specific knowledge are found in patients with hypertension, elevated blood-glucose levels and a history of smoking as well as to pharmacological treatment. Patients generally do not obtain treatment targets with respect to smoking, weight and systolic blood pressure. More long-term individualised, focused education and follow-ups is suggested to obtain increased specific knowledge.

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