Identifying psychosocial predictors of medication non-adherence following acute coronary syndrome: a systematic review

Abstract

Objective: Medication non-adherence following acute coronary syndrome (ACS) is associated with poor clinical outcomes. While most of the research around the determinants of non-adherence has focused primarily on clinical and sociodemographic factors, there is increasing interest into how psychosocial factors affect medication use after ACS. A systematic review was conducted to evaluate the evidence around psychosocial predictors of non-adherence to cardiac medications following ACS. Methods: A search of electronic databases (Cochrane Library, Medline, EMBASE, PsycINFO, Web of Science, International Pharmaceutical Abstracts, CINAHL and ASSIA, OpenGrey, EthOS and WorldCat) was undertaken to identify relevant articles published in English between 2000 and 2014. Articles were screened against our inclusion criteria and data on patient population, study design, predictors, outcomes, statistical analysis, key findings, study quality and study limitations was extracted. Results: Our search identified 3609 records, of which 17 articles met our inclusion criteria. Eight studies found depression predicted medication non-adherence. Patients classified as having Type D personality were more likely to be non-adherent than patients with non-Type D personality. Three studies revealed that treatment beliefs based on the Necessity-Concerns Framework predicted medication non-adherence. Additionally, there was some evidence that increased social support was associated with a better medication adherence. Conclusion: This review summarizes the evidence suggesting that psychosocial factors are important predictors of medication non-adherence. Targeting depressive symptoms, screening for Type D personality, challenging maladaptive treatment beliefs, and providing better social support for patients may be useful strategies to improve rates of adherence following ACS.