Prevalence and predictors of patient adherence to health recommendations after acute coronary syndrome: data for targeted interventions?

Background: Poor adherence is a significant nursing and public health concern because it affects patients' quality of life. It compounds the disease burden of the growing coronary heart disease population. Promoting optimal patient adherence to cardiac-health enhancing recommendations by healthcare providers can reduce mortality and morbidity risk after acute coronary syndrome (ACS). Aim: This paper sought to examine rates and predictors of patient adherence to health recommendations after ACS. Methods: A cross-sectional survey of 210 Malaysian patients using consecutive sampling was conducted in early 2009 at a tertiary teaching hospital. The Medical Outcome Study Specific Adherence Scale (MOSSAS) questionnaire was adapted to measure the extent of patient adherence to recalled health recommendations. Logistic regression modelling was applied to determine odds ratio and factors of suboptimal adherence. Results: The suboptimal adherence rate was 65.2% (95% CI 58.8-71.7%). Recall of recommendation rates varied from 38.1% to 95.3%, whereas the adherence rates varied from 22.1% to 95.1% across the six aspects of health recommendation namely medication taking, dietary modification, regular physical exercise, stress reduction, gathering social support and avoidance of substance abuse. Those who had to adhere to more than three aspects of recommendations, active smokers and the Malay ethnic race had higher odds of suboptimal adherence. Conclusion: Monitoring of patient recall and adherence rate may provide information on the effectiveness of patient care management and outcomes. Identifying patients with higher risk for poor adherence is recommended for more targeted interventions.