- Білоусова, Наталя Анатоліївна (orcid.org/0000-0001-6732-426X), Несукай, Віталій Анатолійович (orcid.org/0009-0004-7394-3277), Сімагіна, Тетяна Володимирівна (orcid.org/0000-0001-5521-9331), Долженко, Марина Миколаївна (orcid.org/0000-0002-8559-9598), Шматенко, Олександр Петрович (orcid.org/0000-0002-6145-460X), Соломенний, Андрій Миколайович (orcid.org/0000-0002-9562-8321) and Тарасенко, Вікторія Олександрівна (orcid.org/0000-0002-3614-6752) (2025) Adherence to treatment among patients with coronary heart disease with comorbid conditions: the impact of socio-economic factors during martial law in Ukraine (second report) Ukrainian Journal of Military Medicine, 2 (6). pp. 111-124. ISSN 2708-6623
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Abstract
Introduction: Cardiovascular disease is known to be the leading cause of death in the world. During martial law in Ukraine, the prevalence of cardiovascular disease is likely to increase. According to the ESC/AHA guidelines and the unified clinical protocol “Stable Coronary Heart Disease”, pharmacotherapy for such patients requires the simultaneous use of up to ten medications, which can impose a significant burden on household budgets and affect adherence to treatment. Given that a large amount of medicines can create a substantial financial strain on patients, it is crucial to improve access to medical services, optimize pharmacotherapy, and create support programs for individuals with cardiovascular diseases. This will not only improve patients’ quality of life, but also reduce the financial stress on families and contribute to better national health outcomes. Purpose is to determine the impact of socioeconomic factors on the adherence to treatment of patients with coronary heart artery disease with comorbidities in Ukraine during wartime. Materials and methods: The study was conducted at the Department of Cardiology of the Shupyk National University of Health of Ukraine by surveying patients suffering from coronary heart disease and comorbidities such as hypertension, type 2 diabetes mellitus, and chronic kidney disease. The online survey was conducted using Google Forms from June to September 2024. The study used the methods of systematization, generalization, deduction and induction, as well as statistical and bibliographic methods of analysis. Results: The risk of failure in the absence of treatment adherence was determined to be almost twice as high: OR = 0.655 [CI 95% 0.540-0.793], compared to the presence of adherence to treatment; the relationship between the average monthly income of respondents and adherence to treatment showed the highest adherence to treatment in patients with an average monthly income from the minimum wage (UAH 8000) to the average wage (< UAH 14576) – 8.9% [CI 95% 8.9 ± 0.001, p < 0.0001]; the relationship between professional employment of respondents and adherence to treatment determined the highest adherence to treatment in patients with unemployed and pensioner status – 53.5% [CI 95% 53.5% ± 0.006, p<0.0001] compared to employed respondents – 16.8% [CI 95% 16.8 ± 0.006, p<0.0001]; the relationship between the educational level of respondents and adherence to pharmacotherapy showed better adherence in patients with higher education (master's degree and above) – 14.9% [CI 95% 14.9 ± 0.002, p<0.0001] compared to the level of vocational education (7.9% [CI 95% 7.9 ± 0.05, p<0.0001]). It has been statistically proven that patients with CHD with comorbidities (76.2% [76.2 ± 0.04, p<0.0001]) and 1-2 socioeconomic risk factors have the lowest adherence to treatment. To address issues related to medocation errors among patients with coronary heart disease (CHD) and comorbidities, as well as to improve adherence to treatment, it is proposed to form multidisciplinary teams that include not only physicians but also pharmacists who will support patients in taking their medications correctly, educate them on the importance of adherence, and assist in resolving treatment-related issues. Conclusions: The study showed that men exhibit higher treatment adherence compared to women, highlighting the need for personalized patient monitoring and flexible treatment adjustments based on changes in health status. In addition, we found statistical significance of the impact of socioeconomic factors, such as education level, financial situation and social status, on adherence to pharmacotherapy. The creation of multidisciplinary teams is proposed to reduce medication errors and improve adherence in patients with CHD and comorbidities. Integrating pharmacists in such teams would ensure proper patient support, provide guidance on correct medication intake, and increase awareness of the importance of treatment adherence. Such a comprehensive approach would help reduce the rate of treatment refusal and significantly improve therapy effectiveness, which is especially important in conditions of limited healthcare access during wartime.
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