Relationship between Patients’ Knowledge about Post Operative Risk Factors after Coronary Artery Bypass Surgery (CABG) and Adherence to Medication and Lifestyle Changes in Armenia

Abstract

Abstract: Background: Medication non-adherence is a complex problem, especially for people with chronic diseases. Non-adherence to lifestyle change and prescribed medication may worsen the disease and can prohibit attaining treatment goals sufficiently. As a result, many patients can loose their chance to get an appropriate benefit from medical treatment. This problem may weaken quality of life and increase health care cost. Non-adherence after CABG is a serious problem, too. It may increase the rate of death, myocardial infarction, recurrent angina, stroke, transient ischemic attack, or the need for re-operation. Aims of the study Primary aim - to investigate the prevalence of non-adherence to medication and lifestyle changes among patients with CABG from 2005 – 2006 at NMMC in Armenia. Secondary aim - to investigate if the knowledge of patients (who underwent CABG) about postoperative risk factors is associated with their adherence to medication and lifestyle changes, such as quitting smoking, following healthier diet and increasing physical activity. Methodology: The study design was analytical cross-sectional. Sample size for this study was 300. Study population consisted of CABG patients who underwent bypass surgery from 2005 to 2006 at NMMC in Armenia, who lived in Armenia, were able to and gave consent to undergo telephone interview. Simple random sampling was used to create the list of study population. Data were collected through telephone interviews. Each interview lasted 10 to 15 minutes. Study Instrument - Medication Adherence Scale Score was use to measure adherence to medication. Behavioral Risk factors Surveillance System (BRFSS) 2006 was used to measure diet, physical activity and smoking status. Beliefs towards medication were assessed by means of Beliefs towards Medication Questionnaire. Knowledge about post operative risk factors was assessed by asking question about post operative risk factors. Results Mean age of participants was 58 ± 9 years, 85.8% were men. Seventeen and 38.6% of patients adhered to medication by the conservative and less conservative definition, respectively. Hundred seventy six (75.5%) were adherent to smoking cessation. Patients with CABG mostly did not adhere to diet: 11 (4.7%) did not follow prescribed dietary changes. Hundred and nine (46.8 %) of patients was considered physically active. Mean knowledge score was 1.88 ± 1.32 (min 0; max 6). Logistic regression was performed to identify the association between knowledge and outcome variables. No statistically significant association was found between knowledge and adherence to medication. There is statistically significant association between medication affordability and adherence to medication by conservative definition, (OR = 3.021, CI = 1.278; 7.141). Statistically significant association was identified between knowledge and smoking cessation (OR = 1.716, CI = 1.235; 2.386). Estimated odds of adherence to diet increases by 63.9%, in each knowledge score increase, OR = 1.639, CI = 1.007; 2.667. Conclusion The study revealed positive association between patients’ knowledge and adherence towards diet and smoking cessation. This finding coupled with results of previous studies allows us to recommend additional patient education measures to address the gap in knowledge of postoperative risk factors in patients with CABG. Further, more research is needed to see whether adherence to medication and lifestyle changes have impact on health outcomes.