J Cardiovasc Nurs. 2020 Jul/Aug;35(4):337-346. doi: 10.1097/JCN.0000000000000650.
BACKGROUND/OBJECTIVES: This study examined whether beliefs about medicines, drug attitudes, and depression independently predicted anticoagulant and antiarrhythmic adherence (focusing on the implementation phase of nonadherence) in patients with atrial fibrillation (AF).
This cross-sectional study was part of a larger longitudinal study. Patients with AF (N = 118) completed the Patient Health Questionnaire-8. The Beliefs about Medicines Questionnaire, Drug Attitude Inventory, and Morisky-Green-Levine Medication Adherence Scale (self-report adherence measure), related to anticoagulants and antiarrhythmics, were also completed. Correlation and multiple logistic regression analyses were conducted.
There were no significant differences in nonadherence to anticoagulants or antiarrhythmics. Greater concerns (r = 0.23, P = .01) were significantly, positively associated with anticoagulant nonadherence only. Depression and drug attitudes were not significantly associated with anticoagulant/antiarrhythmic adherence. Predictors reliably distinguished adherers and nonadherers to anticoagulant medication in the regression model, explaining 14% of the variance, but only concern beliefs (odds ratio, 1.20) made a significant independent contribution to prediction (χ = 11.40, P = .02, with df = 4). When entered independently into a regression model, concerns (odds ratio, 1.24) significantly explained 10.3% of the variance (χ = 7.97, P = .01, with df = 1). Regressions were not significant for antiarrhythmic medication (P = .30).
Specifying medication type is important when examining nonadherence in chronic conditions. Concerns about anticoagulants, rather than depression, were significantly associated with nonadherence to anticoagulants but not antiarrhythmics. Anticoagulant concerns should be targeted at AF clinics, with an aim to reduce nonadherence and potentially modifiable adverse outcomes such as stroke.
背景/目的：本研究旨在探讨患者对药物的信念、药物态度和抑郁是否独立预测心房颤动（AF）患者的抗凝和抗心律失常药物依从性（重点关注依从性的实施阶段）。
这是一项横断面研究，是一项更大的纵向研究的一部分。AF 患者（N=118）完成了患者健康问卷-8 量表。还完成了与抗凝和抗心律失常药物相关的信念量表、药物态度量表和 Morisky-Green-Levine 药物依从性量表（自我报告的依从性测量）。进行了相关性和多元逻辑回归分析。
抗凝和抗心律失常药物的不依从率没有显著差异。对药物的更多担忧（r=0.23，P=0.01）与抗凝药物的不依从显著正相关。抑郁和药物态度与抗凝/抗心律失常药物的依从性无显著相关性。在回归模型中，预测因素可以可靠地区分抗凝药物的依从者和不依从者，解释了 14%的方差，但只有对药物的担忧（优势比，1.20）对预测有显著的独立贡献（χ²=11.40，P=0.02，df=4）。当单独进入回归模型时，对药物的担忧（优势比，1.24）显著解释了 10.3%的方差（χ²=7.97，P=0.01，df=1）。对于抗心律失常药物，回归不显著（P=0.30）。
在检查慢性疾病的不依从性时，明确药物类型很重要。对抗凝药物的担忧，而不是抑郁，与抗凝药物的不依从显著相关，但与抗心律失常药物的不依从无关。应在 AF 诊所针对抗凝药物的担忧进行靶向治疗，以降低不依从率，并可能减少中风等可改变的不良结局。
