Medication non-adherence after myocardial infarction: an exploration of modifying factors.



Medication non-adherence is a major impediment to the management of cardiovascular disease risk factors. A better understanding of the modifying factors underlying medication non-adherence among individuals with known cardiovascular disease may inform approaches for addressing non-adherence.


The purpose of this study was to identify demographic and patient characteristics, medical comorbidities, psychosocial factors, and health belief-related factors associated with medication non-adherence among patients with known cardiovascular disease.


We performed secondary analysis of baseline data from a randomized trial.


The study included 405 patients with a diagnosis of hypertension and history of acute myocardial infarction that was diagnosed within a three-year period prior to enrollment.

Main measures

Baseline demographics and patient characteristics, medical comorbidities, psychosocial factors, health belief-related factors, and patient-reported medication non-adherence were analyzed.

Key results

Of 405 patients, 173 (42.7 %) reported medication non-adherence. Factors associated with non-adherence in bivariate analysis included younger age, non-white race, having less than 12 years of education, smoking, financial insecurity, identifying as nervous or tense, higher life chaos score, greater worry about having a myocardial infarction, and greater worry about having a stroke. Using multivariable modeling, we determined that age (OR 0.97 per additional year, 95 % CI, 0.95-0.99), life chaos (OR 1.06 per additional point, 95 % CI, 1.00-1.11), and worry about stroke (OR 1.12 per additional point, 95 % CI, 1.01-1.25) remained significantly associated with self-reported medication non-adherence.


We found that worry about having a stroke, higher life chaos, and younger age were all significantly associated with self-reported medication non-adherence in patients with cardiovascular disease and a history of myocardial infarction. Further research exploring these factors as targets for intervention is needed, as is additional research examining modifiable causes of medication non-adherence among patients with cardiovascular disease.





Published Version (Please cite this version)


Publication Info

Crowley, Matthew J, Leah L Zullig, Bimal R Shah, Ryan J Shaw, Jennifer H Lindquist, Eric D Peterson and Hayden B Bosworth (2015). Medication non-adherence after myocardial infarction: an exploration of modifying factors. Journal of general internal medicine, 30(1). pp. 83–90. 10.1007/s11606-014-3072-x Retrieved from

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Matthew Janik Crowley

Associate Professor of Medicine

Diabetes, Hypertension, Health Services Research


Leah L Zullig

Professor in Population Health Sciences

Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist. She is a Professor in the Duke Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig’s overarching research interests address three domains: improving cancer care delivery and quality; promoting cancer survivorship and chronic disease management; and improving medication adherence. Throughout these three area of foci Dr. Zullig uses an implementation science lens with the goal of providing equitable care for all by implementing evidence-based practices in a variety of health care environments. She has authored over 150 peer-reviewed publications. 

Dr. Zullig completed her BS in Health Promotion, her MPH in Public Health Administration, and her PhD in Health Policy.

Areas of expertise: Implementation Science, Health Measurement, Health Policy, Health Behavior, Telehealth, and Health Services Research


Bimal Ramesh Shah

Assistant Consulting Professor in the Department of Medicine

Ryan Shaw

Associate Professor in the School of Nursing

Ryan Shaw is at the forefront of integrating patient-generated health data and emerging technologies into novel care delivery models. Using a health equity lens, his research focuses on data from wearables, sensors, and devices that enhance patient care and interact with electronic health records (EHRs). His innovative work has attracted funding from institutions like the US National Institutes of Health (NIH) and the National Science Foundation (NSF).

As the Director of Duke University School of Nursing's Health Innovation Lab, located adjacent to Duke Hospital, he oversees a space for entrepreneurship, product development and testing, and modeling care delivery processes. Additionally, he teaches classes in health informatics and research methods, and mentors students to become the next generation of health scientists and clinicians.

Dr. Shaw's work is shaping the future of healthcare through the integration of technology and patient-centered data in nursing practice.

He currently co-leads two NIH-funded clinical trials:
EXTEND (Grant R01NR019594):
Log2lose (Grant U24HL150227):

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