Prevalence of pharmacological adherence in patients with coronary artery disease and associated factors<sup/>

Padilha, Jaqueline Correia; Santos, Vinicius Batista; Lopes, Camila Takao; Lopes, Juliana de Lima

doi:10.1590/1518-8345.4554.3464

Jaqueline Correia Padilha

Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil.

Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil.

https://orcid.org/0000-0002-8761-6013

Vinicius Batista Santos

Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem Clínica e Cirúrgica, São Paulo, SP, Brazil.

https://orcid.org/0000-0001-5130-5523

Camila Takao Lopes

Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem Clínica e Cirúrgica, São Paulo, SP, Brazil.

https://orcid.org/0000-0002-6243-6497

Juliana de Lima Lopes Corresponding author: Juliana de Lima Lopes E-mail: juliana.lima@unifesp.br

Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem Clínica e Cirúrgica, São Paulo, SP, Brazil.

Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

https://orcid.org/0000-0001-6915-6781

*
Paper extracted from master’s thesis “Fatores que interferem na adesão farmacológica em pacientes com doença arterial coronariana”, presented to Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) – Finance Code 001, Brazil.

Corresponding author: Juliana de Lima Lopes E-mail: juliana.lima@unifesp.br

Authors’ contribution:

Study concept and design: Jaqueline Correia Padilha, Camila Takao Lopes, Juliana de Lima Lopes. Obtaining data: Jaqueline Correia Padilha, Camila Takao Lopes, Juliana de Lima Lopes. Data analysis and interpretation: Jaqueline Correia Padilha, Vinicius Batista Santos, Camila Takao Lopes, Juliana de Lima Lopes. Statistical analysis: Vinicius Batista Santos, Camila Takao Lopes, Juliana de Lima Lopes. Obtaining financing: Juliana de Lima Lopes. Drafting the manuscript: Jaqueline Correia Padilha, Vinicius Batista Santos, Camila Takao Lopes, Juliana de Lima Lopes. Critical review of the manuscript as to its relevant intellectual content: Vinicius Batista Santos, Juliana de Lima Lopes.

All authors approved the final version of the text.

Conflict of interest: the authors have declared that there is no conflict of interest.

Associate Editor: Maria Lúcia do Carmo Cruz Robazzi

Variable	Pharmacological Adherence (n = 85)		Pharmacological Non-Adherence (n = 113)		p-value
Variable	n	%	n	%	p-value
Gender
Female	31	36.5	39	34.5	0.881^* * Pearson's Chi-square test;
Male	54	63.5	74	65.5	0.881^* * Pearson's Chi-square test;
Ethnicity
Caucasian	65	76.5	82	72.6	0.904^* * Pearson's Chi-square test;
African-American	12	14.1	20	17.7
Asian	1	1.2	2	1.8
Mixed (Caucasian and African-American)	7	8.2	9	8
Marital status
Not married	28	32.9	31	27.4	0.435^* * Pearson's Chi-square test;
Married	57	67.1	82	72.6	0.435^* * Pearson's Chi-square test;
Religion
Catholic	51	60	73	64.6	0.221^* * Pearson's Chi-square test;
Evangelical	22	25.9	32	28.3
Jehovah's Witness	3	3.5	1	0.9
Spiritist	3	3.5	0	0
Others	6	7.1	7	6.2
Family history
Positive	61	71.8	79	69.9	0.642^* * Pearson's Chi-square test;
Negative	23	27.1	30	26.5
Does not know	1	1.2	4	3.5
Family assistance in treatment^‡ ‡ Variable that allows for more than one answer;
Financial	9	11.7	11	10.6	0.815^* * Pearson's Chi-square test;
Companion during medical appointments consultation	68	88.3	94	90.4	0.807^* * Pearson's Chi-square test;
Assistance in changing eating habits	2	2.6	3	2.9	1.000^* * Pearson's Chi-square test;
Incentive to treatment	7	9.1	8	7.7	0.789^* * Pearson's Chi-square test;
Self-perception of health
Excellent	1	1.2	1	0.9
Very good	1	1.2	3	2.7
Good	33	38.8	41	36.3
Regular	40	47.1	56	49.6
Poor	10	11.8	12	10.6
Knowledge about the disease
Adequate	76	89.4	99	87.6	0.824^* * Pearson's Chi-square test;
Deficient	9	10.6	14	12.4
	Mean	SD	Mean	SD
Age (years old)	66.61	13.09	65.1	19.97	0.378^† † Student's t-test for independent samples;
	Median	Q25;Q75	Median	Q25;Q75
Children	3	2;5	3	2;4	0.499^§ § Mann-Whitney's U test
Education (years)	8	4;11	4	3;11	0.076^§ § Mann-Whitney's U test

Variable	Pharmacological Adherence (n= 85)		Pharmacological Non-Adherence (n= 13)		p-value
Variable	n	%	n	%
Family income (minimum wages)					0.190^* * Pearson's Chi-Square Test
Up to 1	3	3.5	6	5.3
Between 1 and 3	34	40	60	53.1
Between 3 and 5	15	17.6	21	18.6
Between 5 and 7	13	15.3	9	8
Between 7 and 9	4	4.7	6	5.3
More than 9	16	18.8	11	9.7
Employment Situation					0.449^* * Pearson's Chi-Square Test
Retired/Inactive	54	63.5	78	69
Active	31	36.5	35	31
Type of Housing					0.254^* * Pearson's Chi-Square Test
Own	71	83.5	87	77
Rented	8	9.4	20	17.7
Conceded	6	7.1	6	5.3
Cost of medication					0.466^* * Pearson's Chi-Square Test
Own money	25	29.4	33	29.2
Social resources	13	15.3	11	9.7
Family complementation	47	55.3	69	61.1
Complementation form					0.463^* * Pearson's Chi-Square Test
Own money	63	74.1	82	72.6
Family complementation	9	10.6	18	15.9
Social resources	0	0	1	0.9
No need for complementation	13	15.3	12	10.6
Free transportation
Yes	13	15.3	24	21.2	0.358^* * Pearson's Chi-Square Test
No	72	84.7	89	78.8

Variable	Pharmacological Adherence (n = 85)		Pharmacological Non-Adherence (n = 113)		p-value
Variable	n	%	N	%	p-value
Presence of symptoms^‡ ‡ 164 patients reported having symptoms and could present more than one type;	69	81.2	95	84.1	0.704^* * Pearson's Chi-square test;
Chest pain	39	56.5	61	64.2	0.335^* * Pearson's Chi-square test;
Dyspnea	32	46.4	42	44.2	0.874^* * Pearson's Chi-square test;
Fatigue	7	10.1	1	1.1	0.01^* * Pearson's Chi-square test;
Palpitation	6	8.7	1	1.1	0.042^* * Pearson's Chi-square test;
Previous hospitalization
Yes	60	70.6	75	66.4	0.542^* * Pearson's Chi-square test;
No	25	29.4	38	33.6
Date of last hospitalization					0.383^* * Pearson's Chi-square test;
Never been hospitalized	25	29.4	38	33.6
Less than a year	40	47.1	57	50.4
More than a year	20	23.5	18	16.0
Invasive treatment^§ § 158 patients underwent invasive treatment. Of these, 77 underwent only coronary artery bypass grafting, 47 underwent only percutaneous coronary intervention, and 34 underwent both, totaling 111 coronary artery bypass grafting and 81 percutaneous coronary interventions	66	77.6	92	81.4	0.592^* * Pearson's Chi-square test;
Coronary artery bypass grafting					0.864^* * Pearson's Chi-square test;
Yes	45	52.9	66	58.4
No	40	47.1	47	41.6
Percutaneous coronary intervention					1.000^* * Pearson's Chi-square test;
Yes	34	40.0	47	41.6
No	51	60.0	66	58.4
	mean	SD	Mean	%
Time since diagnosis (months)	82.38	82.36	87.18	98.38	0.805^† † Student's t-test for independent samples;

Variable	Pharmacological Adherence (n = 85)		Pharmacological Non-Adherence (n = 113)		p-value
Variable	n	%	N	%	p-value
Related to the treatment
Side effect
Yes	12	14.1	23	20.4	0.347^* * Pearson's Chi-square test;
No	73	85.9	90	79.6
Complex treatment
Yes	53	62.4	86	76.1	0.042^* * Pearson's Chi-square test;
No	32	37.6	27	23.9
Use of other treatments
Yes	3	3.5	10	8.8	0.158^* * Pearson's Chi-square test;
No	82	96.5	103	91.2
Type of complementary treatment					0.427^* * Pearson's Chi-square test;
Homeopathy	1	1.16	0	0
Home remedies	1	1.16	5	4.4
Religion	1	1.16	2	1.8
Others	0	0	3	2.6
None	82	96.5	103	91.2
Smoking					0.248^* * Pearson's Chi-square test;
Nonsmoker/passive	35	41.2	40	35.4
Daily smoker	15	17.6	15	13.3
Casual smoker	1	1.2	0	0
Former smoker	34	40	58	51.3
Use of alcoholic beverage					0.012^* * Pearson's Chi-square test;
Never drank	47	55.3	40	35.4
Stopped drinking	30	35.3	50	44.2
Drinks	8	9.4	23	20.4
Physical activity					0.478^* * Pearson's Chi-square test;
Never practiced	29	34.1	46	40.7
Practiced, but stopped	42	49.4	54	47.8
Currently practicing	14	16.5	13	11.5
Related to the health care system
Type of Service^§ § The patients could indicate more than one type of care
In the public system	51	60	83	73.5	0.048^* * Pearson's Chi-square test;
In health insurance	37	43.5	32	28.3	0.035^* * Pearson's Chi-square test;
Private service	18	21.2	28	24.8	0.612^* * Pearson's Chi-square test;
Time for access (hour)					0.712^* * Pearson's Chi-square test;
Up to 1	56	65.9	68	60.2
Between 1 and 2	20	23.5	33	29.2
More than 2	9	10.6	12	10.6
Date since last medical appointment (months)					0.922^* * Pearson's Chi-square test;
Less than 6	76	89.4	99	87.6
More than 6	8	9.4	12	10.6
Does not remember	1	1.2	2	1.8
Relationship with the health care professional
Adequate	67	78.8	77	68.1	0.108^* * Pearson's Chi-square test;
Inadequate	18	21.2	36	31.9
	Median	Q25;Q75	Median	Q25;Q75
Treatment duration (months)	120	24;360	48	14;120	0.79^† † Mann Whitney's U test;

Variable	PR^* * PR = Prevalence Ratio;	95% CI^† † CI = Confidence Interval; Minimum Maximum		p-value^‡ ‡ Cox model. Current minimum wage: R$ 937.00 (US$ 166.00)
Greater than 1 to 3 minimum wages	1.168	0.374	3.649	0.790
Greater than 3 to 5 minimum wages	1.564	0.46	5.313	0.473
Greater than 5 to 7 minimum wages	2.291	0.631	8.316	0.208
Greater than 7 to 9 minimum wages	1.094	0.236	5.071	0.909
Greater than 9 minimum wages	2.493	0.608	10.22	0.204
Fatigue	3.308	1.825	5.997	0.001
Palpitation	3.294	2.177	4.983	0.001
Complex treatment	0.697	0.428	1.135	0.147
Other treatments	0.587	0.155	2.227	0.434
Stopped drinking	0.701	0.423	1.163	0.169
Drinks alcoholic beverage	0.347	0.133	0.905	0.031
Public health care system	1.194	0.613	2.322	0.603
Good relationship with the health care team	1.343	0.766	2.353	0.303
Education	1.006	0.951	1.064	0.833

[1] *
Paper extracted from master’s thesis “Fatores que interferem na adesão farmacológica em pacientes com doença arterial coronariana”, presented to Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) – Finance Code 001, Brazil.

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