Antiplatelet Medication Adherence Rates Following Percutaneous Coronary Intervention in Cardiac Patients from Riyadh, Kingdom of Saudi Arabia

Abstract

Background Adherence to antiplatelet medication is paramount for successful management of coronary artery disease, following percutaneous coronary intervention (PCI). Percutaneous coronary intervention is a technique for revascularisation and is the most common treatment for acute coronary syndrome. It is the most frequent treatment for occluded coronary arteries, with high procedural success, with benefits of a short hospital stay, rapid recovery and a return to normal daily life. However, little is understood about post-PCI medication adherence in the Kingdom of Saudi Arabia (KSA) setting. Aim This study explored antiplatelet medication adherence, following PCI, among cardiac patients and addresses a gap in the understanding of antiplatelet medication adherence in the KSA. Method A convergent parallel mixed-methods design, guided by the Theory of Planned Behaviour, was used to attain a deeper comprehension of the phenomenon under study. The quantitative approach involved a survey of patients who had PCI, and the qualitative approach included semi-structured interviews with health professionals. Both descriptive and inferential statistical analyses were undertaken of the quantitative data, which were collected via a survey designed to extract specific information about the demographics, medical history and antiplatelet medication adherence of participants. Interview data were analysed thematically. Finally, the quantitative and qualitative data were combined for comparison and reinforcement and the data interpreted separately as well as comparatively. Results The rate of antiplatelet medication adherence was low for more than half of the survey participants (55.4 %), one-third reported medium adherence (34.8%) and only 9.9% reported high adherence. Majority of the patients had comorbidities, with more than half suffering from heart disease (52.3%), high blood pressure (57.7%) or diabetes (54%). Majority of the participants had only undergone one PCI procedure (62.3%) typically in an emergency (65.5%). Participants with high blood pressure were 2.38 times more likely to be adherent to their medication regime than those without high blood pressure. The qualitative results showed that health professionals not only play their individual unique role to support antiplatelet medication adherence among patients but also align their roles for a systematic approach. The factors affecting antiplatelet medication adherence highlighted by health professionals included family support, language proficiency and differences of comprehension capacity of rural and urban patients. The healthcare system supported the antiplatelet medication adherence among patients by providing free medication and consultation. However, access to medical facilities transpired as a barrier as medical centres were in major urban cities only. Health professionals highlighted that patient’s medical condition, polypharmacy and their health literacy influenced their antiplatelet medication adherence. Conclusion Medication non-adherence is prevalent among cardiac patients following PCI in the KSA. This study identified enablers and barriers to antiplatelet medication adherence among participants. Results suggest that health professionals should be required to explore amendable obstacles to promote medication adherence. Structured medication education should be undertaken to examine and discuss the concerns of patients regarding their medications and the services provided to them, and to provide suggestions that will empower them. These recommendations will inform practice and may enhance patients’ antiplatelet medication adherence.