Keenan Jan
1 Oxford University Hospitals NHS Foundation Trust, UK.
2 Faculty of Health Sciences, University of Southampton, UK.
Eur J Prev Cardiol. 2017 Jun;24(3_suppl):29-35. doi: 10.1177/2047487317708145.
Survivors of myocardial infarction are at risk of recurrent events and have an annual death rate of 5%. Advances in treatment and, in particular, the interventional management of myocardial infarction have seen important mortality gains over recent decades, yet cardiovascular diseases remain the biggest killer in many European countries. Change in lifestyle and adherence to medication to prevent further events are key to the recurrence of future events following myocardial infarction, but adherence to medication for the secondary prevention of cardiovascular disease is a profound problem. This article outlines a growing evidence base about the complex nature of adherence as a psychological phenomenon that is influenced by the nature of the event itself, illness perception and factors related to medication beliefs that cannot be addressed simply through a combination of educational approaches. A whole-systems approach is advocated, starting with the education of health professionals to understand the psychology of adherence, and to react comfortably to patients decisions about medication, with a pivotal role for follow-up in secondary care and cardiac rehabilitation.
心肌梗死幸存者面临复发事件的风险，年死亡率为5%。在过去几十年中，治疗方面的进展，尤其是心肌梗死的介入治疗，已使死亡率显著降低，但心血管疾病在许多欧洲国家仍是最大的杀手。改变生活方式和坚持服药以预防进一步事件是心肌梗死后未来事件复发的关键，但坚持心血管疾病二级预防用药是一个严重问题。本文概述了越来越多的证据，表明依从性作为一种心理现象具有复杂性，它受到事件本身的性质、疾病认知以及与药物信念相关因素的影响，而不能仅仅通过综合教育方法来解决。提倡采用全系统方法，首先要对卫生专业人员进行教育，使其了解依从性心理，并能坦然应对患者关于用药的决定，二级护理和心脏康复中的随访起着关键作用。
