Development of a predictive model for adherence to pharmacological treatment in ischemic heart disease: consideration of psychosociocultural, neuropsychological, and mental health variables

Abstract Introduction Adherence to pharmacological treatment recommendations is the main preventable cause of rehospitalization and premature mortality in patients diagnosed with ischemic heart disease, which in turn, is permeated by modifiable psychosocial risk factors such as anxiety, depression, stress, type A behavior pattern, inhibitory control, attitudes and behavioral beliefs towards the disease and treatment. The objective of this study was to develop and test a model to predict adherence to pharmacological treatment in patients with ischemic heart disease undergoing coronary revascularization surgery based on psychosocial, neuropsychological and mental health variables. Material and Methods Cross-sectional study with a sample of 691 patients between 45 and 82 years of age (M= 52 years, SD= 12.15), 46% women and 54% men, diagnosed with ischemic heart disease and undergoing coronary revascularization surgery. Anthropometric, cardiovascular and psychosocial risk factors were evaluated. The scales were designed and validated to assess adherence to pharmacological treatment in ischemic heart disease by means of EFA and CFA, which showed adequate internal consistency indicators and psychometric properties. Results Using the AMOS v.24 statistical package, a path analysis was performed for the variable of adherence to pharmacological treatment, with attitudes toward the disease and treatment, behavioral beliefs, and inhibitory control (executive function) as direct predictors, explaining 54% of the variance in adherence to pharmacological treatment in ischemic heart disease, and the model fit indices were: χ2(33) =261. 19; CMIN/DF= 7.91; TLI= .893; NFI= .815; IFI= .901; CFI= .900; AGFI= .822, SRMR= 2.727; RMSEA=.053. Conclusions The findings of this research contribute to the understanding of adherence to pharmacological treatment in ischemic heart disease as a process and not only as an isolated construct, in which mental health intervenes interacting with psychosocial and cultural aspects of the patient with respect to their disease and pharmacological treatment and in turn provides evidence that inhibitory control as an executive function. This provides evidence that inhibitory control as an executive function is useful for understanding adherence to pharmacological treatment, which shows the need to incorporate in the hospital setting comprehensive psychological evaluations and interventions that allow us to predict adherence to pharmacological treatment of ischemic heart disease in order to intervene in the processes involved, which could contribute to the prevention of rehospitalization and premature mortality.