Factors affecting adherence to medication, smoking cessation, and exercise in patients with peripheral artery disease

Objective

Adherence to peripheral artery disease (PAD) treatment reduces the risk of cardiovascular events and delays disease progression, but patients do not fully adhere to their treatment regimens. This pilot study aimed to identify the adherence levels of patients with PAD and how these are related to sociodemographics, clinical factors, and illness perceptions.

Methods

Patients with PAD were recruited during outpatient appointments at a London teaching hospital between January and May 2022. Data were collected from medical records and questionnaires, including the self-reported Morinsky Medication Adherence Scale (MMAS-8) and the Brief Illness Perceptions Questionnaire (BIPQ). Descriptive statistics, χ², independent sample tests, and one-way analysis were conducted using SPSS.

Results

A total of 105 patients participated and completed the questionnaire. Of these, 73.3% were male, with a mean age of 69.5 years. Of the patients, 41.9% and 36.2% had high antiplatelet and statin adherence, respectively, defined by an MMAS >8 score. One-quarter were current smokers, whereas only 17.1% of patients had previously attended a supervised exercise class. High adherence to antiplatelets and statins was associated with older age (P = .006 and P = .047) and previous vascular interventions (P = .004 and P = .009). Low antiplatelet adherence was linked to lower perceived control (P = .041), treatment control (P = .019), and disease understanding (P = .049). Patients perceiving their medical therapy as less effective showed lower statin adherence (P = .036). Being a current or ex-smoker was related to feeling less in control of care (P = .013). High exercise frequency was associated with lower consequences (P = .041) and identity scores (P = .031). Limited walking distance was linked to higher disease impact on daily quality of life (P < .001), lower perceived treatment effectiveness (P = .002), lower perceived personal control (P = .018), severe claudication symptoms (P < .001), and higher concerns (P = .001) and emotional distress (P < .001).

Conclusions

Treatment adherence among patients with PAD is notably low. Patients’ illness perceptions play a significant role in understanding and explaining this lack of adherence. To improve treatment adherence, interventions should particularly focus on addressing and modifying negative illness perceptions.