Azhar Saeed, Hadiqa Khushnood Qazi, Syeda Sunia Abbas, Syed Danial Kamal, Muhammad Khan


Introduction: Cardiovascular diseases are on the rise and one of the major causes of deaths worldwide. Medications can greatly lower the mortality rate by delaying the progression of the disease. These patients have the problem of non‐adherence to their medications due to many factors. Successful management of treatment depends on adequate self‐care and knowledge of patients about their disease and medications which indirectly affects medication adherence behavior. The objectives of the study were to find the frequency of medication non-adherence in two public and private tertiary care hospitals of Peshawar and the factors which determine non-adherence.

Materials & Methods: A comparative cross-sectional study was conducted in the months of April-May 2016 at Hayatabad Medical Complex (HMC) and Rehman Medical Institute (RMI) Peshawar, which together treat a sizable proportion of cardiovascular disease patients of this region. A calculated sample of 168 patients was selected for the study (84 per hospital) based on convenience sampling; the 8-item Morisky Scale (MMAS-8), validated in patients with Diabetes Mellitus, Heart Failure, and Coronary Artery Diseases was used to assess adherence. Factors affecting medication non-adherence were documented with an indigenous questionnaire which was developed after a pilot study done in both the hospitals. Data analysis was done by SPSS 16.0 for descriptive statistics, while comparison of hospitals was done by the Chi Square test; multinomial regression analysis was done for factors affecting adherence levels. A p≤0.05 was considered significant.

Results: Of the 168 patients from both hospitals, 107(63.7%) were males, and 61(36.3%) were females. The ages of the participants ranged from 19-84 years with a mean age of 55.33±10.61 years. Medication adherence calculated for both hospitals showed high adherence of 20.2%, medium adherence of 22.6%, and low adherence of 57.1%. Income per month (p=0.006), co-morbidities (p=0.002) and fear of getting addicted to the medication (p=0.048) were found to be the main factors affecting medication adherence; hospitals were significantly associated with adherence levels (p<0.001).

Conclusion: Income, education status, cost of healthcare, and co-morbidities are factors leading to low medication adherence among cardiovascular disease patients, more so in the public tertiary care sector.

Keywords: Medication Adherence; Cardiovascular Diseases; Self Care; Health Care Costs; Drug Costs.

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NHS Choices. Cardiovascular disease. [Online]. [cited 2015 Dec 31]; Available from:

Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009 Jun;119(23):3028-35.

Saleem F, Hassali MA, Shafie AA, Awad AG, Bashir S. Association between knowledge and drug adherence in patients with hypertension in Quetta, Pakistan. Tropical Journal of Pharmaceutical Research. April 2011;10(2):125-32.

Gul AM. Cardiovascular disease in South East Asia. [Editorial]. Pak Heart J. 2015;48(03):118-9.

Baroletti S, Dell’Orfano H. Medication adherence in cardiovascular disease. Circulation. 2010 Mar 30;121(12):1455-8.

Munger MA, Van Tassell BW, LaFleur J. Medication nonadherence: an unrecognized cardiovascular risk factor. MedGenMed. 2007 Sep 19;9(3):58.

Hovstadius B, Petersson G. Non-adherence to drug therapy and drug acquisition costs in a national population - a patient-based register study. BMC Health Serv Res. 2011 Nov 28; 11(1):326.

Lynch SS. Adherence to a Drug Regimen. Merck Manuals Professional Edition [Internet]. [cited 2016 Jan 8]. Available from:

Lindsay JT, Heaney LG. Nonadherence in difficult asthma - facts, myths, and a time to act. Patient Prefer Adherence. 2013 Jan;7:329-36.

Kolandaivelu K, Leiden BB, O’Gara PT, Bhatt DL. Non-adherence to cardiovascular medications. Eur Heart J. 2014 Dec 7;35(46):3267-76.

Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011 Apr;86(4):304-14.

Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011 May;26(3):155-9.

Roebuck MC, Liberman JN, Gemmill-Toyama M, Brennan TA. Medication adherence leads to lower health care use and costs despite increased drug spending. Health Aff. 2011 Jan 1;30(1):91-9.

Santhosh YL, Naveen MR. Medication adherence behavior in chronic diseases like asthma and diabetes mellitus. Int J Pharm Pharm Sci. 2011;3(3):238-40.

Lavsa SM, Holzworth A, Ansani NT. Selection of a validated scale for measuring medication adherence. J Am Pharm Assoc (2003). 2011 Jan-Feb;51(1):90-4.

Bilal A, Riaz M, Shafiq N, Ahmed M, Sheikh S, Rasheed S. Non-compliance to anti-hypertensive medication and its associated factors among hypertensives. J Ayub Med Coll Abbottabad. 2016 Nov 7;27(1):158-63.

Hashmi SK, Afridi MB, Abbas K, Sajwani RA, Saleheen D, Frossard PM, et al. Factors associated with adherence to anti-hypertensive treatment in Pakistan. PLoS One. 2007 Mar 14;2(3):e280.

Al-Ramahi R. Adherence to medications and associated factors: A cross-sectional study among Palestinian hypertensive patients. J Epidemiol Glob Health. 2015;5(2):125-32.

Malik A, Yoshida Y, Erkin T, Salim D, Hamajima N. Hypertension-related knowledge, practice and drug adherence among inpatients of a hospital in Samarkand, Uzbekistan. Nagoya J Med Sci. 2014;76(3-4):255-63.

Santra G. Assessment of adherence to cardiovascular medicines in rural population: an observational study in patients attending a tertiary care hospital. Indian J Pharmacol. 2015;47(6):600-4.

Thakur JS, Vijayvergiya R, Jaswal N, Ginsburg A. Assessment and barriers to medication adherence for secondary prevention of cardiovascular disease among patients with coronary artery disease in Chandigarh, India. Int J Non-Commun Dis. 2016;1(1):37-41.


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