Koroner arter hastalığı olanlarda medikal tedavi ve yaşam tarzı değişikliklerine uyumun değerlendirilmesi

Yıl 2022, Cilt: 15 Sayı: 2, 239 - 250, 01.04.2022

İpek Büber , Cihan İlyas Sevgican

https://doi.org/10.31362/patd.1053205

Öz

Amaç: Koroner arter hastalığı (KAH) için sekonder korumada medikal tedavi (MT) yaşam tarzı değişikliklerine
(YTD) uyum hastalığa bağlı mortalite ve morbiditeyi azaltmaktadır. Bu çalışmada KAH hastalarında MT ve
YTD’ye uyumu etkileyen parametrelerin araştırılması amaçlanmıştır.
Gereç ve yöntem: En az bir yıl önce farklı sebeplerle koroner anjiografi yapılarak KAH tanısı almış ardışık 396
hastaya uyumu değerlendirmek üzere standardize edilmiş anket uygulanmıştır.
Bulgular: Hastaların %20,9’u (n=83) YTD’ye uyumsuz, %42,4’ü (n=168) orta derecede uyumlu, %36,6’sı
(n=145) uyumlu saptanmıştır. %81,1’i ise (n=321) MT’ye tam uyumlu saptanmıştır. Erkek cinsiyet (RA:1,966,
p=0,023), daha genç yaş (yaş, RA:0,958, p=0,002), KABG yapılması YTD’ye uyumu arttırırken (RA:2,635,
p=0,015), ST elevasyonsuz miyokart enfarktüsü/unstabil angina pektoris nedeniyle koroner anjiografi yapılmış
olması (RA:0,344, p=0,001) ve ST elevasyonlu miyokart enfarktüsü/ölümcül aritmi nedeniyle koroner anjiografi
yapılmış olması (RA:0,472 p=0,014) YTD’ye tam uyumluluk üzerine negatif etkilidir. Hipertansiyon varlığı
(RA:5,779 p<0,001), ST elevasyonlu miyokart enfarktüsü/ölümcül aritmi (RA:3,736, p=0,029) varlığı MT’ye
uyumu arttırırken, perkütan koroner girişim uygulanması (RA:0,132, p=0,002) MT’ye uyumu azaltmaktadır.
Sonuç: Ülkemizde KAH hastalarında MT’ye uyum YTD’ye uyumdan daha yüksektir. Genç yaş erkek hastalar
YTD’ye daha fazla uyum sağlarken bu etki MT’de saptanmamıştır. Gelir düzeyinin orta ve yüksek olması YTD’ne
uyumu pozitif yönde etkilerken

Anahtar Kelimeler

Yaşam tarzı değişikliklerine uyum, medikal tedaviye uyum, koroner arter hastalığı

Evaluation of adherence to medical treatment and lifestyle changes at coronary artery disease

Öz

Purpose: Adherence to medical treatment (MT) and lifestyle changes (LC) in secondary prevention for coronary
artery disease (CAD) reduces disease-related mortality and morbidity. In this study, we aimed to investigate the
parameters affecting compliance with MT and LC in patients with CAD.
Material and method: A standardized questionnaire was applied to 396 consecutive patients who were
diagnosed with CAD by performing coronary angiography for different reasons at least one year ago, to evaluate
adherence.
Results: 20.9% of the patients (n=83) were found to be non-adherent to LC, 42.4% (n=168) were intermediateadherent,
and 36.6% (n=145) were adherent. 81.1% (n=321) of the patients were found to be fully adherent
to MT. Male gender (CI:1.966, p=0.023), younger age (age, RA:0.958, p=0.002), performing coronary artery
bypass grafting (CI:2.635, p=0.015) increased adherence to LC, conversely non-ST elevation myocardial
infarction/unstable angina pectoris (CI:0.344, p=0.001) and ST-elevation myocardial infarction/fatal arrhythmia
(CI:0.472 p=0.014) decreased adherence. Presence of hypertension (CI:5,779, p<0.001), ST-elevation
myocardial infarction/fatal arrhythmia (CI:3.736, p=0.029) increased adherence to MT but percutaneous
coronary intervention (CI:0.132, p=0.002) decreased adherence to MT.
Conclusion: Adherence to MT is higher than LC in patients with CAD in our study population. Younger
male patients were more adherent to LC but this effect was not observedadherence to LC. The medium and
high-income level positively affected

Anahtar Kelimeler

Adherence to medically treatment, adherence to lifestyle changes, coronary artery disease

Kaynakça

• KAYNAKLAR 1. Hanna IR, Wenger NK. Secondary prevention of coronary heart disease in elderly patients. Am Fam Physician, 2005. 71(12): p. 2289-96.
• 2. Han E, Suh DC, Lee SM, Jang S. The impact of medication adherence on health outcomes for chronic metabolic diseases: a retrospective cohort study. Res Social Adm Pharm, 2014. 10(6): p. e87-e98.
• 3. Cutler RL, Fernandez-Llimos F, Frommer M, Benrimoj C, Garcia-Cardenas V. Economic impact of medication non-adherence by disease groups: a systematic review. BMJ Open, 2018. 8(1): p. e016982.
• 4. Melloni C, Alexander KP, Ou FS, LaPointe NM, Roe MT, Newby LK, et al., Predictors of early discontinuation of evidence-based medicine after acute coronary syndrome. Am J Cardiol, 2009. 104(2): p. 175-81.
• 5. Ho PM, Magid DJ, Shetterly SM, Olson KL, Maddox TM, Peterson PN, et al., Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease. Am Heart J, 2008. 155(4): p. 772-9.
• 6. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al., 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Kardiol Pol, 2016. 74(11): p. 1234-1318.
• 7. Chen HY, Saczynski JS, Lapane KL, Kiefe CI, Goldberg RJ. Adherence to evidence-based secondary prevention pharmacotherapy in patients after an acute coronary syndrome: A systematic review. Heart Lung, 2015. 44(4): p. 299-308. 8. Jackevicius CA, Li P, Tu JV. Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction. Circulation, 2008. 117(8): p. 1028-36.
• 9. Lee YM, Kim RB, Lee HJ, Kim K, Shin MH, Park HK, et al., Relationships among medication adherence, lifestyle modification, and health-related quality of life in patients with acute myocardial infarction: a cross-sectional study. Health Qual Life Outcomes, 2018. 16(1): p. 100.
• 10. Franklin JM, Krumme AA, Shrank WH, Matlin OS, Brennan TA, Choudhry NK. Predicting adherence trajectory using initial patterns of medication filling. Am J Manag Care, 2015. 21(9): p. e537-44.
• 11. Lu M, Hravnak M, Ma J, Lin Y, Zhang X, Shen Y, et al., Prediction of Changes in Adherence to Secondary Prevention Among Patients With Coronary Artery Disease. Nurs Res, 2020. 69(5): p. E199-E207.
• 12. Lee HY, Cooke CE, Robertson TA. Robertson, Use of secondary prevention drug therapy in patients with acute coronary syndrome after hospital discharge. J Manag Care Pharm, 2008. 14(3): p. 271-80.
• 13. August KJ, Sorkin DH. Marital status and gender differences in managing a chronic illness: the function of health-related social control. Soc Sci Med, 2010. 71(10): p. 1831-8.
• 14. Margolis, R, Educational differences in healthy behavior changes and adherence among middle-aged Americans. J Health Soc Behav, 2013. 54(3): p. 353-68.
• 15. Molloy GJ, Perkins-Porras L, Strike PC, Steptoe A. Social networks and partner stress as predictors of adherence to medication, rehabilitation attendance, and quality of life following acute coronary syndrome. Health Psychol, 2008. 27(1): p. 52-8.
• 16. Naderi SH, Bestwick JP, Wald DS . Wald, Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med, 2012. 125(9): p. 882-7 e1.
• 17. Hardy SE, Concato J, Gill TM. Gill, Stressful life events among community-living older persons. J Gen Intern Med, 2002. 17(11): p. 832-8.
• 18. Bulut S, Kafadar D, Yakupoğlu E, Okuyan E. Evaluatıon of the assocıatıon of medıcatıon adherence wıth polypharmacy and multımorbıdıty ın patıents wıth coronary artery dısease, ankara med j, 2020;(4):777-789 // 10.5505/amj.2020.67044
• 19. Özdemir T, Şahin İ, Avcı İİ, Güngör B, Durmaz E, Tuğrul S, et al., Assessment of factors related to statin non-adherence in patients with established coronary artery disease: A single-center observational study. Turk Kardiyol Dern Ars, 2017. 45(8): p. 723-730.