More than one in four patients hospitalised for coronary artery disease report high medication concerns: findings from a multicentre observational cohort study

Background Patients’ medication beliefs influence medication adherence. The “Beliefs about Medicine Questionnaire Specific” (BMQ-S) identifies four attitudinal profiles (accepting, ambivalent, indifferent, sceptical), based on the balance between perceived necessity of treatment against concerns about medication. Whether clinical characteristics are associated with these profiles among patients hospitalised for acute coronary syndrome (ACS) or elective coronary revascularisation remains unclear. Purpose To investigate the prevalence of medication belief profiles in patients hospitalised for ACS or elective coronary revascularisation and to assess their association with clinical characteristics. Methods We enrolled patients from 26 Dutch medical centres during hospitalisation for ACS or elective coronary revascularisation (percutaneous coronary intervention or coronary artery bypass graft). Clinical data were collected from electronic health records. During admission, patients received an email survey on demographics, BMQ-S with an additional item on side-effects, and prior medication adherence (1-100 visual analogue scale). Surveys completed ≤ 14 days after discharge were included. Based on BMQ-S necessity and concern scores, patients were classified into beliefs profiles (accepting, ambivalent, indifferent, or sceptical) using the scale midpoint. Multinomial regression was performed to assess associations between characteristics and these profiles, with ´accepting´ as reference category. Results Between June 2024 and February 2026, 1013 patients (24% women; median age 68 years) completed the survey (response rate 50%) a median of 3 days after discharge (IQR 1-7). Based on BMQ-S scores, 59% of patients were accepting, 22% ambivalent, 14% indifferent, and 6% sceptical. Self-reported medication adherence was high across all profiles. High-concern patients (ambivalent or sceptical) more often reported that their medication causes side effects than accepting and indifferent patients. Older age was associated with lower odds of being sceptical than accepting (OR 0.97 per year; [0.94-1.00]). Non-smokers, patients with prior medication use, or a history of cardiovascular disease (CVD) were less likely to be indifferent than accepting (OR 0.47 [0.25-0.90], 0.35 [0.22-0.54], and 0.63 [0.42-0.93], respectively). No significant associations were observed between attitudinal profiles and sex or reason for admission. Conclusions Nearly 30% of patients report ambivalent or sceptical medication beliefs during or shortly after hospitalisation for ACS or elective coronary revascularisation. These high-concern profiles showed limited associations with measured clinical characteristics. Non-smokers, patients with a history of CVD, or those who used medication prior to admission were more likely to be accepting. Long-term follow-up is needed to assess how medication beliefs evolve over time.Table 1.Characteristics