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From the The Toronto Hospital (J.I., B.B., J.S., S.J.), Departments of Psychiatry (J.I., B.B.) and Medicine (P.D.), University of Toronto, and St. Michael’s Hospital (M.P., P.D.), Toronto, Ontario; Dean, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (J.C.); and Departments of Medicine (S.C.) and Clinical Epidemiology and Biostatistics (R.R., M.G.), McMaster University, Hamilton, Ontario, Canada.
Address reprint requests to: Jane Irvine, DPhil, CPsych, Psychology Department, cw-2-330, The Toronto Hospital, 200 Elizabeth St., Toronto, Ontario, Canada, M5G 2C4. Email: jane.irvine{at}utoronto.ca
OBJECTIVE: This study examined the relationship between adherence, mortality, and psychosocial factors.
METHODS: Subjects were 1141 patients participating in the Canadian Amiodarone Myocardial Infarction Arrhythmia Trial. Poor adherence to study medication (amiodarone or placebo), measured by pill count over 2 years, was defined as the lower 20th percentile of the pill count distribution. Predictors of adherence were also studied and included demographic and cardiac variables and, in a subset of participants (N = 671), measures of depression, distress, hostility, and social support.
RESULTS: In survival analysis controlling for cardiac and demographic variables, poor adherence in the placebo and amiodarone groups was associated with an increased risk of sudden cardiac death (relative risk (RR) = 2.11, 95% confidence interval (CI) = 1.03–4.56, p < .05; and RR = 3.15, 95% CI = 1.34–7.44, p < .01, respectively), total cardiac mortality (RR = 2.04, 95% CI = 1.12–3.72, p < .02; and RR = 2.49, 95% CI = 1.32–4.72, p < .01, respectively), and all-cause mortality (RR = 2.25, 95% CI = 1.27–3.97, p < .001; and RR = 2.34, 95% CI = 1.32–4.17, p < .004, respectively). Logistic regression analysis identified two predictors of poor adherence to placebo: age > 70 years (odds ratio = 2.18, 95% CI = 1.11–4.29, p < .03) and social activities in the month before the index heart attack (odds ratio = 1.02, 95% CI = 1.00–1.04, p < .05).
CONCLUSIONS: Poor adherence is associated with a greater risk of mortality. The relationship between adherence and social activities suggests a higher motivation to adhere to treatment in individuals more engaged in enjoyable activities.
Key Words: adherence • placebo therapy • mortality
Abbreviations: CAMIAT = Canadian Amiodarone Myocardial Infarction ArrhythmiaTrial; CHF = congestive heart failure; CI = confidenceinterval; MI = myocardial infarction; OR = odds ratio; RR = relative risk; SCD = sudden cardiac death; VPD =ventricular premature depoloarization.
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