Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.
Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand.
Open Heart. 2018 Dec 16;5(2):e000877. doi: 10.1136/openhrt-2018-000877. eCollection 2018.
The cardiac inherited disease (CID) population has suboptimal adherence to long-term β-blocker therapy, which is known to be a risk for sudden cardiac death. This study aimed to identify the clinical and psychosocial variables associated with non-adherence in this population.
130 individuals (aged 16-81 years, median: 54) from the New Zealand Cardiac Inherited Disease Registry taking β-blockers participated: 65 (50%) long QT syndrome, 42 (32%) hypertrophic cardiomyopathy and 23 (18%) other. Participants completed one questionnaire recording self-reported adherence, anxiety, depression, confidence in taking medication, illness perceptions and medication beliefs. Demographic and clinical variables were taken from the registry.
21 participants (16%) were classed as non-adherent. Bivariate analysis showed that self-reported adherence was worse in those who were younger (p<0.001), had a channelopathy not cardiomyopathy (p<0.01), reported lower confidence in taking β-blockers (p<0.001), had high concerns (p<0.05) and low necessity beliefs about their β-blocker (p<0.001), a poorer understanding of their CID (p<0.01), and lower treatment control beliefs (p<0.01). These variables accounted for 37% of the variance in adherence in a linear regression model. Stronger beliefs around medication necessity and higher confidence in their ability to take their medication predicted β-blocker adherence.
Factors associated with β-blocker non-adherence in patients with CID include young age, having a channelopathy, negative medication beliefs, low confidence in taking medication and poor illness perceptions. These findings present an opportunity to develop targeted interventions to improve adherence.
患有遗传性心脏病（CID）的患者对长期β受体阻滞剂治疗的依从性较差，而这已知是导致心源性猝死的风险因素。本研究旨在确定与该人群药物依从性差相关的临床和心理社会因素。
130 名来自新西兰遗传性心脏病登记处的正在服用β受体阻滞剂的患者参与了这项研究：65 名（50%）长 QT 综合征患者、42 名（32%）肥厚型心肌病患者和 23 名（18%）其他疾病患者。参与者完成了一份问卷，记录了他们的自我报告的依从性、焦虑、抑郁、对服药的信心、疾病认知和药物信念。人口统计学和临床变量取自登记处。
21 名患者（16%）被归类为不依从。单变量分析显示，年龄较小的患者自我报告的依从性更差（p<0.001），患有通道病而不是心肌病（p<0.01），报告对服用β受体阻滞剂的信心较低（p<0.001），对β受体阻滞剂的关注度较高（p<0.05）和低必要性信念（p<0.001），对自身 CID 的理解较差（p<0.01），以及治疗控制信念较低（p<0.01）。在一个线性回归模型中，这些变量解释了依从性变化的 37%。对药物必要性的信念越强，对自己服药能力的信心越高，预测β受体阻滞剂的依从性越好。
CID 患者β受体阻滞剂不依从的相关因素包括年龄较小、患有通道病、负面的药物信念、对服药的信心较低和较差的疾病认知。这些发现为开发旨在提高依从性的靶向干预措施提供了机会。
