Assessment of Dietary and Drug Adherence amongst Cardiovascular Disease Patients Admitted for Hospitalization in Lebanon

Abstract

Background: CVD is increasing at an alarming rate worldwide, reaching epidemic proportions in countries of the Eastern Mediterranean Region, including Lebanon. Despite the growing proportions of patients suffering from CVDs, there is a scarcity of data on whether these patients adhere to therapeutic dietary guidelines, drug prescriptions and physical activity recommendations and whether such adherence differs according to demographic, socioeconomic, lifestyle, behavioral or psychosocial characteristics.

Objectives: This study aims to assess adherence to dietary guidelines, drug regimens and physical activity recommendations amongst CVD patients admitted for hospitalization in Lebanon, as well as to describe their demographic, socioeconomic, lifestyle, behavioral, and psychosocial characteristics and investigate the association of these characteristics with dietary, drug and physical activity adherence in the study population.

Methods: A cross-sectional study was conducted among 367 Lebanese adult CVD patients admitted for hospitalization at various hospital sites in Lebanon (AUBMC, AWH, LMC, and CHN). Patients were interviewed to collect information on demographic, socioeconomic, lifestyle, psychosocial, and behavioral characteristics. Dietary assessment was performed using a culture-specific validated food frequency questionnaire, and physical activity (PA) levels were assessed using the international physical activity questionnaire (IPAQ). Anthropometric measurements, blood pressure, and biochemical markers were collected from the patient’s medical charts. Mental well-being was assessed based on the World Health Organization 5 items well-being index (WHO-5) and drug adherence was assessed using the 8 items Morisky medication adherence scale (MMAS-8). The median and IQR were reported for continuous variables and frequencies and percentages for categorical variables. Regression analyses were used to investigate associations between variables.

Results: The majority of the patients were males (67.8%), overweight or obese (74%), smokers (62.1%), unemployed or retired (54.5%) and previously diagnosed with high blood pressure (61%). Almost 35% of the patients were found to be lonely and nearly one in four patients (26%) were at a high risk of poor mental health. Approximately two-thirds of the patients were found to have poor adherence to drug prescriptions (69%), and close to half had low levels of PA (52%). In this study sample, poor dietary adherence was estimated at almost 43% for the American Heart Association (AHA) dietary guidelines and 45% for the Therapeutic Lifestyle Changes (TLC) diet. Loneliness was significantly associated with lower odds of drug adherence (OR= 0.4, 95% CI: 0.21-0.8), while patient’s admission to hospitals other than AUBMC as well as patient’s perception of having high-income status were significantly associated with higher odds of adherence compared to patients who perceived to have low-income status (OR= 40.7, 95% CI: 11.35-146 and OR= 3.08, 95% CI: 1.1-8.7). A lower sense of well-being was associated with lower odds of adherence to the AHA dietary recommendations (OR=0.2, 95% CI: 0.067-0.69), while overweight and obesity were associated with higher odds of diet adherence (OR=5.9; 95% CI: 1.4-25.9), reflecting potential reverse causality bias. Owning a house was a significant predictor of adherence to the TLC diet (OR=2.86, 95% CI: 1.1-7.48). Finally, female gender and high levels of loneliness were inversely associated with high PA (OR=0.38, 95% CI: 0.23-0.66; and OR=0.5, 95% CI: 0.31-0.8).

Conclusion: This study showed that dietary and drug adherence rates were low in this patient population and that close to half did not follow the PA recommendations. Importantly, the study identified several demographics, socioeconomic, and psychosocial characteristics that may affect the patients’ adherence to diet, drug and PA recommendations. These findings may serve as the basis for future interventions aimed at enhancing adherence amongst CVD patients and thus improving their health status and quality of life.