Kosobucka Agata, Michalski Piotr, Pietrzykowski Łukasz, Kasprzak Michał, Obońska Karolina, Fabiszak Tomasz, Felsmann Mirosława, Kubica Aldona
Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
Department of Cardiology and Internal Diseases, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
Patient Prefer Adherence. 2018 Mar 5;12:333-340. doi: 10.2147/PPA.S150435. eCollection 2018.
A substantial subset of patients after myocardial infarction (MI) discontinue pivotal medication early after discharge. In particular, cessation of antiplatelet treatment may lead to catastrophic ischemic events. Thus, adherence to prescribed medication in patients after MI is an issue of medical and social concern.
The aim of the study was to evaluate the level of adherence to treatment using a newly developed scale in patients after MI treated with percutaneous coronary intervention.
A single-center, prospective, observational cohort clinical study with a 6-month follow-up was performed. Patients with physical or cognitive impairment, prisoners, soldiers, and family members and coworkers of the researchers were excluded from the study. The impact of selected sociodemographic and clinical factors on adherence was evaluated in 221 patients (63 women and 158 men) aged 30 to 91 years.
The results obtained with the Adherence in Chronic Diseases Scale (ACDS) ranged from 7 to 28 points; with the average and median scored being 23.35 and 24, respectively. The ACDS score reflects the level of adherence to prescribed medication. The high ACDS scores (>26 points) were obtained in 59 (26.7%) patients, intermediate scores (21-26 points) in 110 (49.8%) and low scores (<21 points) in 52 subjects (23.5%). Acute coronary syndrome (re-ACS) occurred in 18 (8.1%) patients during the follow-up period. The high-level adherence (ACDS score >26 points) was found in 11.1% of patients with re-ACS vs 28.4% of the remaining ones (=0.1). Lower scores (mean ± standard deviation) in re-ACS patients were found for items 2 and 3 of the ACDS: 3.11±0.68 vs 3.45±0.73 (=0.02) and 3.28±0.89 vs 3.64±0.64 (=0.04), respectively.
Age and previous MI were found to be independent factors influencing adherence assessed with the ACDS.
心肌梗死（MI）后相当一部分患者在出院后早期就停止服用关键药物。特别是，抗血小板治疗的中断可能导致灾难性的缺血事件。因此，心肌梗死后患者对规定药物的依从性是一个医学和社会关注的问题。
本研究的目的是使用一种新开发的量表评估经皮冠状动脉介入治疗的心肌梗死后患者的治疗依从性水平。
进行了一项单中心、前瞻性、观察性队列临床研究，随访6个月。研究排除了身体或认知障碍患者、囚犯、士兵以及研究人员的家庭成员和同事。在221名年龄在30至91岁之间的患者（63名女性和158名男性）中评估了选定的社会人口统计学和临床因素对依从性的影响。
慢性病依从性量表（ACDS）获得的结果范围为7至28分；平均得分和中位数得分分别为23.35和24分。ACDS分数反映了对规定药物的依从性水平。59名（26.7%）患者获得了高ACDS分数（>26分），110名（49.8%）患者获得了中等分数（21 - 26分），52名受试者（23.5%）获得了低分数（<21分）。随访期间18名（8.1%）患者发生了急性冠状动脉综合征（再发急性冠状动脉综合征，re - ACS）。再发急性冠状动脉综合征患者中11.1%的患者具有高依从性水平（ACDS分数>26分），其余患者中这一比例为28.4%（P = 0.1）。再发急性冠状动脉综合征患者的ACDS第2项和第3项得分（均值±标准差）较低：分别为3.11±0.68 vs 3.45±0.73（P = 0.02）和3.28±0.89 vs 3.64±0.64（P = 0.04）。
年龄和既往心肌梗死被发现是影响通过ACDS评估的依从性的独立因素。
