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Health Qual Life Outcomes. 2018 May 22;16(1):100. doi: 10.1186/s12955-018-0921-z.

Relationships among medication adherence, lifestyle modification, and health-related quality of life in patients with acute myocardial infarction: a cross-sectional study.

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Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.
Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, South Korea.
Department of Preventive Medicine, College of Medicine and Institute of Health Science, Gyeongsang National University, 15 Jinju-daero, 816 Beon-gil, Jinju, 52727, South Korea.
Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Chuncheon, South Korea.
Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, South Korea.
Daejeon-Chungnam Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, South Korea.
Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University Hospital, Cheongju, South Korea.
Department of Preventive Medicine &Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, South Korea.
Busan-Ulsan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, South Korea.
Center for preventive medicine and public health, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, South Korea.
Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, South Korea.
Department of Preventive Medicine, College of Medicine and Institute of Health Science, Gyeongsang National University, 15 Jinju-daero, 816 Beon-gil, Jinju, 52727, South Korea.



The healthy adherer effect is a phenomenon in which patients who adhere to medical therapies tend to pursue health-seeking behaviors. Although the healthy adherer effect is supposed to affect health outcomes in patients with coronary artery disease, evaluation of its presence and extent is not easy. This study aimed to assess the relationship between medication adherence and lifestyle modifications and health-related quality of life among post-acute myocardial infarction (AMI) patients.


A cross-sectional study was conducted in 417 post-AMI patients who underwent percutaneous coronary intervention (PCI). Patients were recruited from 11 university hospitals from December 2015 to March 2016 in South Korea. Details regarding socio-demographic factors, six health behaviors (low-salt intake, low-fat diet and/or weight-loss diet, regular exercise, stress reduction in daily life, drinking in moderation, and smoking cessation), medication adherence using the Modified Morisky Scale (MMS), and HRQoL using the Coronary Revascularization Outcome Questionnaire (CROQ) were surveyed in a one-on-one interview.


In the univariate logistic analysis, sex (female), age (≥70 years), MMS score (≥5), and CROQ score were associated with adherence to lifestyle modification. In the multiple logistic analysis, a high MMS score (≥5) was associated with adherence to lifestyle modification after adjusting for sex, age, marital status, education, and family income (adjusted odds ratio [OR] = 11.7, 95% confidence interval [CI] = 1.5-91.3). After further adjusting for the CROQ score, the association between high MMS score and adherence to lifestyle modification was significant (adjusted OR = 11.5, 95% CI = 1.4-93.3).


Adherence to medication was associated with adherence to lifestyle modification, suggesting the possible presence of the healthy adherer effect in post-AMI patients. After further adjusting for HRQoL, the association remained. To improve health outcome in post-AMI patients, early detection of patients with poor adherence to medication and lifestyle modification and motivational education programs to improve adherence are important. In addition, the healthy adherer effect should be considered in clinical research, in particular, in studies evaluating the effects of therapies on health outcomes.


Health behavior; Health-related quality of life; Healthy adherer effect; Lifestyle modification; Medication adherence; Myocardial infarction; Secondary prevention

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