Frequency and predictors of non-adherence to lifestyle modifications and medications after coronary artery bypass grafting: A cross-sectional study

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary heart disease following isolated primary coronary artery bypass grafting (CABG) (n=265). Intervention: Predictors of post-CABG lifestyle and medication non-adherence (e.g., unwillingness to adopt a new lifestyle, >1 social gathering/week, reluctance to exercise, forgetfulness) vs. Adherent post-CABG patients without these risk factors. Primary outcome: Frequency of self-reported non-adherence to dietary recommendations, exercise, and prescribed medications.

Q: What does this research mean for the field?

Patients recovering from coronary artery bypass grafting exhibit high rates of non-adherence to dietary recommendations (45.3%), exercise (41.1%), and medications (26.0%), driven by psychological reluctance, social barriers, fear of cardiac harm, and forgetfulness. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Muhammad Armughan Ali; Javeria Yasir; Rida Noor Sherwani; Marium Fareed; Fizza Arshad; Fareeha Abid; Ramsha Ghazal Arshad; Safana Ismail; Sarim Ahmed Khan; UroojJamal Siddiqui; Marium Gul Muhammad; Kaneez Fatima

doi:10.1016/j.ihj.2017.05.017

May 29, 2017Indian Heart JournalOpen Access

Frequency and predictors of non-adherence to lifestyle modifications and medications after coronary artery bypass grafting: A cross-sectional study

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Key result

Post-CABG patients show high non-adherence early post-surgery, led by ~45% dietary non-adherence.

n=265

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Why the study?

What are the frequencies and predictors of non-adherence to dietary modifications, exercise, and prescribed medications among patients following isolated primary coronary artery bypass grafting?

Key Points

To assess the frequency and predictors of non-adherence to lifestyle modifications and prescribed medications among patients following coronary artery bypass grafting (CABG).
Cross-sectional descriptive study of 265 patients who underwent isolated primary CABG.
Self-reported adherence to diet, exercise, and medications was evaluated via a pre-coded questionnaire completed at a mean follow-up of 5.7 ± 1.3 weeks (≥4 weeks post-surgery).
Predictors and statistical significance were evaluated using the Chi-square test.
Non-adherence was reported by 45.3% (n=120) of patients for dietary recommendations, 41.1% (n=109) for exercise, and 26% (n=69) for prescribed medications.
Dietary non-adherence was significantly predicted by attending >1 social gathering per week (OR 9.1; 95% CI 4.9–16.7; p<0.001) and unwillingness to adopt a new lifestyle (OR 6.7; 95% CI 3.8–11.9; p<0.001).
Significant predictors of exercise non-adherence included reluctance to follow a regimen (OR 14; 95% CI 6.3–31.4; p<0.001) and a busy schedule (OR 9.2; 95% CI 5.2–16.4; p<0.001), while medication non-adherence was strongly linked to forgetfulness (OR 16.7; 95% CI 6–46.5; p<0.001).

Study Design

Type

Cross-Sectional (n=265)

Multicenter

Yes

Structured PICO

What are the frequencies and predictors of non-adherence to dietary modifications, exercise, and prescribed medications among patients following isolated primary coronary artery bypass grafting?

P

Population

265 adult patients (mean age 67.2 years, 40.8% female) in Pakistan who underwent isolated primary CABG surgery, assessed at a mean follow-up of 5.7 weeks.

E

Exposure

Exposure to patient-level and social barriers to adherence (unwillingness to adopt new lifestyle, >1 social gathering/week, lack of partner/family support, reluctance to exercise, busy schedule, fear of aggravating heart condition, forgetfulness, polypharmacy, medication cost)

O

Outcome

Frequency and predictors of self-reported non-adherence to dietary recommendations, exercise guidelines (safe walking 30-60 min/day for ≥3 days/week), and prescribed medications (Morisky Scale 8 score of 3-8) at a mean follow-up of 5.7 ± 1.3 weeks post-CABGpatient reported

Early post-CABG non-adherence to diet (45.3%), exercise (41.1%), and medication (26%) is highly prevalent and driven by modifiable patient beliefs, social habits, forgetfulness, and cost, underscoring the need for targeted physician counseling and family support.

Limitations

Previous history of smoking was not correlated with current change in habits or inability to do so
Did not consider adherence to different specific types of drugs and their varying side effects
Short follow-up duration (conducted at 4 or more weeks post-CABG, mean 5.7 weeks)
Solely self-reported adherence measures subject to recall and social desirability bias
Small sample size selected via non-randomized convenience sampling from only two tertiary care hospitals in Karachi
Previous history of smoking was not correlated with current change in habits
Adherence to different types of specific drugs was not considered, which could lead to confounding bias from varying side effects
Short follow-up duration (after 4 weeks of CABG), unable to determine long-term compliance changes
Self-reported adherence measures subject to recall bias and social desirability bias
Small sample size recruited via convenience sampling from only two tertiary care hospitals in Karachi, limiting generalizability and introducing selection bias

Implication

High early non-adherence post-CABG warrants attention; leaves open whether addressing predictors improves outcomes in prospective studies.

Abstract

BACKGROUND: Non-adherence to dietary recommendations, exercise and prescribed drug regimens, in coronary heart disease (CHD) patients following coronary artery bypass grafting (CABG), is a major health care issue worldwide. AIMS AND OBJECTIVES: The primary objective of this study was to investigate the frequency and predictors of non-adherence to lifestyle changes and medication among CHD patients after undergoing CABG surgery. METHOD: The sample of this cross sectional descriptive study was 265 patients who underwent isolated primary CABG. Participants who met the eligibility criteria were provided with a pre-coded questionnaire 4 weeks or more after surgery. Adherence was assessed on the basis of patient's self-report. Significance of results was analyzed using Chi square test. RESULTS: Roughly half of the patients were non-adherent to dietary recommendations (n=120, 45.3%) and exercise (n=109, 41.1%) while about one third (n=69, 26%) were non-adherent to prescribed medications. Unwillingness to adopt a new lifestyle and more than one social gathering per week, were found to be statistically significant predictors of non-adherence to diet (p-values<0.001). Reluctance to follow exercise regimen, busy schedule, and fear that exercise will aggravate heart issues were commonly reported as reasons for non-compliance to exercise. As for non-adherence to medication, forgetfulness, affordability of drugs and too many medications to take were important predictors. CONCLUSION: Non-adherence to lifestyle modifications and medication is an emerging problem worldwide. It is essential for medical health professionals to discuss these predictors and address them individually. Our findings highlight the need for a healthy physician and patient relationship.

Discussion

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Cite This Study

Ali et al. (2017) conducted a cross-sectional in Coronary heart disease following isolated primary coronary artery bypass grafting (CABG) (n=265). Predictors of post-CABG lifestyle and medication non-adherence (e.g., unwillingness to adopt a new lifestyle, >1 social gathering/week, reluctance to exercise, forgetfulness) vs. Adherent post-CABG patients without these risk factors was evaluated on Frequency of self-reported non-adherence to dietary recommendations, exercise, and prescribed medications. Post-CABG patients exhibited high rates of non-adherence to diet (45.3%), exercise (41.1%), and prescribed medications (26.0%) at a mean of 5.7 weeks after surgery.

synapsesocial.com/papers/6a7706b0e539f649abf6d672 https://doi.org/10.1016/j.ihj.2017.05.017

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Frequency and predictors of non-adherence to lifestyle modifications and medications after coronary artery bypass grafting: A cross-sectional study

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Frequency and predictors of non-adherence to lifestyle modifications and medications after coronary artery bypass grafting: A cross-sectional study

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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