Understandings and experiences of adherence to secondary prevention for patients with cardiovascular disease and comorbid depression or anxiety

ABSTRACT

Over 20% of cardiovascular disease (CVD) patients have a comorbid mental health disorder, resulting in an increased risk of recurring major adverse cardiac events (MACE) and mortality. Despite the higher risk, patients with comorbid depression or anxiety disorders are twice as likely to be non-adherent to secondary prevention. Therefore, better understanding of the adherence experiences of this subgroup is needed to inform service delivery and enhance adherence for this higher risk group. This study aims to explore the perceptions, understandings, and experiences of adherence to secondary prevention amongst 33 cardiac patients with diagnosed depression and/or anxiety disorder. Participants were recruited as part of the Cardiovascular Health in Anxiety or Mood Problems Study. Semi-structured interviews were conducted and data were analysed via inductive thematic analysis. Patient understandings of adherence to secondary prevention were limited, with medication compliance considered the marker of adherence. Further, participants did not perceive unintentional non-adherence to constitute non-adherence, rather an intent to engage was viewed as defining adherence. Participants also reported that a lack of practitioner understanding and management around their mental health negatively impacted the practitioner–patient relationship and their engagement with secondary prevention. Results highlight that unique barriers, especially around management of comorbid mental health exist for this subgroup. Additionally, adherence to secondary prevention might be limited by patients’ narrow understandings of adherence as the intent to engage and as medication compliance.

KEYWORDS:

• Psychological distress
• psychiatric morbidity
• wellbeing
• barriers
• quality of life
• cardiac rehabilitation
• facilitators
• coronary heart disease

Acknowledgments

The authors wish to thank Marilyn Black, Peter Cheung, and Marg McGee for their assistance with CHAMPS

Data availability statement

The datasets for this manuscript are not publicly available because of data management and confidentiality constraints imposed by local laws, the governing institution, and human research ethics committee. Requests to access the datasets should be directed to PT, [email protected]

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Heart Foundation of Australia Vanguard Grant (100593) and the Menzies Foundation Allied Health Scholars Grant (AHS_004). PT was supported by the National Health and Medical Research Council of Australia (Neil Hamilton Fairley – Clinical Overseas Fellowship #1053578).