Challenges adhering to a medication regimen following first-time percutaneous coronary intervention: A patient perspective

• Published in: International journal of nursing studies 2018-12, Vol.88, p.16-24
• Main Authors: Pettersen, Trond R., Fridlund, Bengt, Bendz, Bjørn, Nordrehaug, Jan Erik, Rotevatn, Svein, Schjøtt, Jan, Norekvål, Tone M.
• Format: Article
• Language: English
• Subjects: Adherence; Age differences; Angioplasty; Anticoagulants; Cardiac surgery; Cardiology; Cardiovascular disease; Cognitive impairment; Content analysis; Coronary artery disease; Coronary vessels; Disease management; Drugs; Early intervention; Fatigue; Generic prescribing; Independent living; Intervention; Medication adherence; Nursing; Omvårdnad; Pain; Patient compliance; Patient-centered care; Patients; Percutaneous coronary intervention; Prescription drugs; Qualitative research; Sampling; Self care; Seriousness; Side effects; Stents
• ISSN: 0020-7489; 1873-491X; 1873-491X
• DOI: 10.1016/j.ijnurstu.2018.07.013

Percutaneous coronary intervention is the most common therapeutic intervention for patients with narrowed coronary arteries due to coronary artery disease. Although it is known that patients with coronary artery disease often do not adhere to their medication regimen, little is known about what patients undergoing percutaneous coronary interventions find challenging in adhering to their medication regimen after hospital discharge. To explore patients’ experiences in adhering to medications following early post-discharge after first-time percutaneous coronary intervention. An abductive qualitative approach was used to conduct in-depth interviews of patients undergoing first-time percutaneous coronary intervention. Participants were recruited from a single tertiary university hospital, which services a large geographical area in western Norway. Patients fulfilling the inclusion criteria were identified through the Norwegian Registry for Invasive Cardiology. Participants were patients aged 18 years or older who had their first percutaneous coronary intervention six to nine months earlier, were living at home at the time of study inclusion, and were prescribed dual antiplatelet therapy. Patients who were cognitively impaired, had previously undergone cardiac surgery, and/or were prescribed anticoagulation therapy with warfarin or novel oral anticoagulants were excluded. Purposeful sampling was used to include patients of different gender, age, and geographic settings. Twenty-two patients (12 men) were interviewed between December 2016 and April 2017. Face-to-face semi-structured interviews were conducted, guided by a set of predetermined open-ended questions to gather patient experiences on factors relating to medication adherence or non-adherence. Transcribed interviews were analysed by qualitative content analysis. Patients failed to adhere to their medication regimen for several reasons; intentional and unintentional reasons, multifaceted side effects from heart medications, scepticism towards generic drugs, lack of information regarding seriousness of disease after percutaneous coronary intervention, psychological impact of living with coronary artery disease, and these interacted. There were patients who felt that the medication information they received from physicians and nurses was uninformative and inadequate. Side effects from heart medications were common, ranging from minor ones to more disabling side effects, such as severe muscle and joint pain a