Barriers to adherence to secondary prevention therapy in patients with ischemic heart disease: a cross-sectional study of a Mexican reference center

José R. Orozco-Moreno, Clínica de Miocardiopatias, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México; Departamento de Cardiología, Centro Médico Nacional de Occidente, Guadalajara, Jalisco; México
Enrique A. Berríos-Bárcenas, Grupo de Estudio de Hipertensión y Mecánica Vascular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Dante Palacios-Gutierrez, Clínica de Miocardiopatias, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Alfonso R. Aldaco-Rodríguez, Clínica de Miocardiopatias, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Nydia Avila-Vanzzini, Clínica de Miocardiopatias, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Jorge E. Cossío-Aranda, Sociedad Mexicana de Cardiología, Ciudad de México, México
Claudia Del Valle-Chávez, Clínica de Miocardiopatias, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Mario Leyva-Balderas, Clínica de Miocardiopatias, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
José A. Maza-Larrea, Clínica de Miocardiopatias, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México; Departmento de Farmacología Clínica y Farmacovigilancia, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México; México
Francisco J. Roldán-Gómez, Clínica de Miocardiopatias, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México

Objective: This article aims to assess the adherence level to second-line therapy for cardiovascular prevention in a tertiary hospital in Mexico City and identify key barriers to adequate pharmacological adherence. Methods: A single-center prospective cross-sectional study was conducted between August 2018 and February 2020. Sociodemographic data were collected, and the Morisky medication adherence scale was performed. Directed interviews during medical consultations were also conducted to determine reasons for non-adherence. Results: Showed that out of 991 patients included with a median age of 65 (58.72) years, 70.3% exhibited inadequate adherence, with forgetfulness being the most common reason (55.4%). Patients receiving combined therapy with coronary revascularization showed higher adherence compared to those on optimal medical therapy alone. Low educational level (OR 1.68, IC 95% 1.23-2.23, p = 0.0001) and the use of optimal medical therapy alone (OR 1.2, I 95% 1.11-2.007 p = 0.007) were identified as predictors of poor adherence. Conclusion: Among patients with ischemic heart disease and pharmacological therapy for secondary prevention, inadequate adherence is observed in 70% of cases. Factors associated with poor pharmacological adherence were low educational level and prescription of medical therapy without revascularization.

Keywords: Therapy adherence. Ischemic heart disease. Secondary prevention. Optimal medical therapy. Cardiovascular disease. Disease burden.