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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 2, March/April 2019
AFRICA
113
Review Articles
Assessment of adherence to medication for
cardiovascular diseases: measurement tools
Bartosz Uchmanowicz, Anna Szyma
ń
ska-Chabowska, Beata Jankowska-Pola
ń
ska
Abstract
The effectiveness of treatment and prevention of chronic
illnesses can be optimised with adherence to medication treat-
ment. This is very often assessed by means of a self-report.
However, the challenge here is to choose the most suitable
questionnaire or the one that is best overall in a given situa-
tion. The aim of this systematic review was to assess existing
self-reported medication adherence scales, which measure
adherence to treatment for cardiovascular disease. The review
demonstrated that relatively few disease-specific adherence
scales exist. Generic questionnaires and those specific to
adherence to hypertension treatment are the most numerous.
Questionnaires specifically measuring adherence to anti-
haemorrhage treatment for atrial fibrillation are particularly
necessary and noticeably absent. The two most important
aspects that need to be taken into account when selecting the
most appropriate scale in a given context are the subject of
the measurement (what) and the method of validation (how).
Keywords:
adherence, cardiovascular disease, questionnaires,
measurement
Submitted 24/1/18, accepted 4/10/18
Published online 23/1/19
Cardiovasc J Afr
2019;
30
: 113–119
www.cvja.co.zaDOI: 10.5830/CVJA-2018-050
Adherence measures for cardiovascular patients
Adherence to treatment is essential to a treatment’s effectiveness.
The identification of non-adherent patients and of factors that
contribute to non-adherence remains a fundamental challenge
for treatment teams providing care to cardiovascular patients.
Understanding the causes of non-adherence will enable the
development of multidisciplinary intervention programmmes
focused on promoting healthy behaviours, knowledge and
treatment adherence.
1
The World Health Organisation (WHO) estimates that only
one in two patients complies with the treatment prescribed.
Non-adherence typically involves taking lower or higher doses,
temporarily or permanently discontinuing treatment, and
simultaneously taking over-the-counter medication. Factors that
contribute to lower pharmaceutical adherence include: old age,
cognitive impairment, physical disability, depression, lack of
social support, poor socio-economic standing, co-morbidities,
drug interactions and adverse effects, long duration of treatment,
polypharmacy, a large number of doses to be taken within a
single day, and poorly functioning healthcare systems.
2
The term adherence is used to describe the extent to which
a patient follows medical advice, which includes taking the
medication as prescribed. Adherence is understood as the
patient’s informed and voluntary involvement in the accepted
treatment process. This definition implies an empowerment
of the patient, who agrees with the physician on the treatment
objectives (concordance). Therefore, treatment adherence means
that the patient takes the medication as prescribed, and does not
interrupt the treatment out of an unwillingness to continue. The
definition of adherence includes two aspects: one is the intensity
of involvement in following the recommendations; the other is
persisting with compliant behaviour throughout the treatment
period.
3
Areas of special interest in cardiovascular treatment include
chronic treatment for hypertension and heart failure, and
anticoagulation treatment for atrial fibrillation, due to the
increasing incidence of these problems in the population,
especially among the elderly.
Non-adherence to treatment is the most common reason
for poor blood pressure (BP) control in hypertensive patients.
Despite advances in pharmaceutical treatment for hypertension,
epidemiological studies in Poland have demonstrated that the
primary factor contributing to an unsatisfactory response
to pharmaceutical treatment is poor compliance/adherence.
Approximately 40 to 60% of hypertensive patients do not comply
with the prescribed treatment.
4
Atrial fibrillation (AF) mainly affects elderly individuals
(3.7–4.2% of patients aged 60–70 years, and 10–17% of those
aged 80 and above). In the treatment of AF, adherence to
anticoagulant treatment in elderly patients is a significant
challenge. On one hand, oral anticoagulants decrease the risk of
an ischaemic stroke, but on the other, they increase the risk of
haemorrhaging. Available data show that between 10 and 26% of
patients discontinue warfarin treatment within the first year of
Department of Clinical Nursing, Faculty of Health Science,
Wroclaw Medical University, Wroclaw, Poland
Bartosz Uchmanowicz, MD
Beata Jankowska-Pola
ń
ska, RN
Department of Internal Medicine, Occupational Diseases,
Hypertension and Clinical Oncology, Wroclaw Medical
University, Wroclaw, Poland
Anna Szyma
ń
ska-Chabowska, MD, PhD,
aszyman@mp.pl