A three-year longitudinal study of healthy lifestyle behaviors and adherence to pharmacological treatments in newly diagnosed patients with acute coronary syndrome: hierarchical linear modeling analyses
Journal of Public Health
Aim Healthy lifestyle behaviors and a good adherence to pharmacological treatments are important predictors of lower recurrence rates and better overall outcomes among patients with an established acute coronary syndrome (ACS). The present study sought to investigate the longitudinal trajectories of these behaviors years after the onset of an ACS. Subject and methods We recruited a sample of 275 newly diagnosed consecutive patients at their first ACS event (mean age: 57.1 ± 7.87 years; 84%
... .87 years; 84% males) admitted to a cardiac rehabilitation program from three large public hospitals in Northern Italy. Patients completed a battery of sociodemographic questionnaires, which evaluated healthy lifestyles (smoking status, alcohol intake, diet, and physical activity) and adherence to pharmacological treatments, at five time-points (pre-event, 6-, 12-, 24-, and 36-month follow-ups). Longitudinal trajectories were examined through hierarchical (generalized) linear models, controlling for several demographic and clinical variables. Results We found significant changes in all healthy lifestyles from pre-event to the 6-month follow-up, suggesting the adoption of healthier behaviors soon after the cardiac event. However, from the 6-month up to the 3-year follow-up, patients experienced small but significant declines in their self-reported levels of healthy dietary behaviors and physical activity. Further, we found that the odds of being at medium risk of non-adherence to the pharmacological treatments significantly increased over the course of 3 years. Conclusion Given the negative long-term trajectories in specific lifestyles and adherence to pharmacological treatments, cardiac rehabilitation programs are suggested to provide repeated psychological interventions aimed at fostering patients' capabilities to self-regulate their habitual behaviors. Keywords Acute coronary syndrome . Healthy behaviors . Adherence to pharmacological treatments . Diet . Physical activity Acute coronary syndrome (ACS) is one of the most frequent causes of hospitalization in developed countries (Piepoli et al. 2016) , and it is associated with high rates of morbidity, mortality, and a substantial economic and psychosocial burden (Nabel and Braunwald 2012; Piepoli et al. 2016; Ruff and Braunwald 2010). Patients with ACS also have a higher risk of recurrent cardiovascular events (Piepoli et al. 2016) , and thus their clinical management is challenging. Modifiable risk Andrea Greco and Agostino Brugnera are co-first authors.