Medication Adherence, Quality of Life, and Rehospitalization in Post-Acute Coronary Syndrome Patients
Downloads
Background: Post-ACS patients often face an increased likelihood of mortality, rehospitalization, and diminished quality of life as a consequence of poor medication adherence. Objective: This study aimed to evaluate the level of adherence to medication in post-ACS patients and its relationship with quality of life and rehospitalization rates. Methods: A cross-sectional, observational, single-center, prospective study conducted at Universitas Airlangga Teaching Hospital, Surabaya. Compliance with medication was evaluated using the Adherence Refill Medication Scale-7 (ARMS-7) questionnaire, while quality of life was measured using the Short Form-36 (SF-36) Quality of Life questionnaire. Rehospitalization rates were obtained through direct interviews and medical record observations within 45 days of hospital discharge. Results: In total, 39 patients participated in this study, with overall adherence rates of 35.89% for all prescribed medications, 53.85% for antiplatelets, 38.46% for statins, 55.56% for beta-blockers, and 58.06% for ACEIs/ARBs. Among the quality-of-life dimensions, social functioning had the highest score (93.01 ± 15.89), whereas physical role functioning had the lowest score (40.39 ± 35.18). Within 45 days of hospital discharge, 26% of the patients experienced rehospitalization. Statistical analysis indicated a positive correlation between adherence to all prescribed medications and physical role functioning in relation to QoL (p = 0.038). In addition, overall medication adherence was negatively correlated with the risk of rehospitalization (p = 0.019). Conclusion: Total medication adherence was associated with improved physical function and rehospitalization events. Providing education can lead to better therapeutic outcomes, improved quality of life, and reduced rehospitalization in patients.
Adam, A., Tiluata, L., Yunita, L., Putra, M., Wilujeng, N., Homalessy, L., & Hutabarat, D. (2022). A Clinical Profile of Acute Coronary Syndrome Patients in Kupang. Indonesian Journal of Cardiology; 42; 109-118. doi: 10.30701/ijc.1194.
Aljabery, M. A., Rajeh Saifan, A., Alrimawi, I., Alzoubi, A. M., & Atout, M. (2022). The Associations Between Patients’ Characteristics and the Quality of Life Among Acute Coronary Syndrome Patients in Jordan: A Cross-Sectional Study. SAGE Open Nursing; 8; 1-7. doi: 10.1177/23779608221129129.
Anchah, L., Hassali, M. A., Lim, M. S., Ibrahim, M. I., Sim, K. H., & Ong, T. K. (2017). Health Related Quality of Life Assessment in Acute Coronary Syndrome Patients: The Effectiveness of Early Phase I Cardiac Rehabilitation. Health Qual Life Outcomes; 15; 1-14. doi: 10.1186/s12955-016-0583-7.
Bansilal, S., Castellano, J. M., Garrido, E., Wei, H. G., Freeman, A., Spettell, C., Garcia-Alonso, F., Lizano, I., Arnold, R. J., Rajda, J., Steinberg, G., & Fuster, V. (2016). Assessing the Impact of Medication Adherence on Long-Term Cardiovascular Outcomes. Journal of the American College of Cardiology; 68; 789-801. doi: 10.1016/j.jacc.2016.06.005.
Collet, J. P., Thiele, H., Barbato, E., Barthélémy, O., Bauersachs, J., Bhatt, D. L., Dendale, P., Dorobantu, M., Edvardsen, T., Folliguet, T., Gale, C. P., Gilard, M., Jobs, A., Jüni, P., Lambrinou, E., Lewis, B. S., Mehilli, J., Meliga, E., Merkely, B., Mueller, C., Roffi, M., Rutten, F. H., Sibbing, D., Siontis, G. C. M.; ESC Scientific Document Group. (2021). 2020 ESC Guidelines for the Management Of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-segment Elevation. European Heart Journal; 42; 1289-1367. doi: 10.1093/eurheartj/ehaa575.
de Carvalho Costa, I.M.N.B., da Silva, D.G., Oliveira, J.L.M., Silva, J.R.S., de Andrade, F.A., de Góes Jorge, J., de Oliveira, L.M.S.M., de Almeida, R.R., Oliveira, V.B., Martins, L.S., Costa, J.O., de Souza, M.F.C., Pereira, L.M.C., Alves, L.V.S., Voci, S.M., Almeida-Santos, M.A., Aidar, F.J., Baumworcel, L., Sousa, A.C.S. (2022). Quality of Life among Patients with Acute Coronary Syndromes Receiving Care from Public and Private Health Care Systems in Brazil. Clinics and Practice; 12; 513-526. doi: 10.3390/clinpract12040055.
Dou, L., Mao, Z., Fu, Q., Chen, G., Li, S. (2022). Health-Related Quality of Life and Its Influencing Factors in Patients with Coronary Heart Disease in China. Patient Prefer Adherence; 16; 781-795. doi: 10.2147/PPA.S347681.
Goss, F., Brachmann, J., Hamm, C.W., Haerer, W., Reifart, N., Levenson, B. (2017). High Adherence to Therapy and Low Cardiac Mortality and Morbidity in Patients After Acute Coronary Syndrome Systematically Managed by Office-Based Cardiologists in Germany: 1-Year Outcomes of the ProAcor Study. Vascular Health and Risk Management; 13; 127-137. doi: 10.2147/VHRM.S119490.
Hess, C. N., Wang, T. Y., McCoy, L. A., Messenger, J. C., Effron, M. B., Zettler, M. E., Henry, T. D., Peterson, E. D., & Fonarow, G. C. (2016). Unplanned Inpatient and Observation Rehospitalizations After Acute Myocardial Infarction: Insights From the Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Study. Circulation; 133; 493-501. doi: 10.1161/CIRCULATIONAHA.115.017001.
Karim, M. T., Inam, S., Ashraf, T., Shah, N., Adil, S. O., & Shafique, K. (2018). Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan. Journal of Preventive Medicine and Public Health; 51; 71-82. doi: 10.3961/jpmph.17.189.
Lee, Y. M., Kim, R. B., Lee, H. J., Kim, K., Shin, M. H., Park, H. K., Ahn, S. K., Kim, S. Y., Lee, Y. H., Kim, B. G., Lee, H., Lee ,W. K., Lee, K. S., Kim, M. J., & Park, K. S. (2018). Relationships Among Medication Adherence, Lifestyle Modification, and Health-Related Quality of Life in Patients with Acute Myocardial Infarction: A Cross-Sectional Study. Health Qual Life Outcomes; 16; 1-8. doi: 10.1186/s12955-018-0921-z.
Lisiak, M., Uchmanowicz, I., & Wontor, R. (2016). Frailty and Quality of Life in Elderly Patients with Acute Coronary Syndrome. Clinical Interventions in Aging; 11; 553-62. doi: 10.2147/CIA.S99842.
Luu, N. M., Dinh, A. T., Nguyen, T. T. H., & Nguyen, V. H. (2019). Adherence to Antiplatelet Therapy after Coronary Intervention among Patients with Myocardial Infarction Attending Vietnam National Heart Institute. BioMed Research International; 6585040; 1-7. doi: 10.1155/2019/6585040.
Mathews, R., Wang, W., Kaltenbach, L. A., Thomas, L., Shah, R. U., Ali, M., Peterson, E. D., & Wang, T. Y. (2018). Hospital Variation in Adherence Rates to Secondary Prevention Medications and the Implications on Quality. Circulation; 137; 2128-2138. doi: 10.1161/CIRCULATIONAHA.117.029160.
Murad, H., Basheikh, M., Zayed, M., Albeladi, R., & Alsayed, Y. (2022). The Association Between Medication Non-Adherence and Early and Late Readmission Rates for Patients with Acute Coronary Syndrome. International Journal of General Medicine; 15; 6791-6799. doi: 10.2147/IJGM.S376926.
Nurhamsyah, D., Trisyani, Y., Nuraeni, A., & Maziyya, N. (2021). Severity Level and Quality of Life of Post-Acute Coronary Syndrome Patients. Jurnal Keperawatan Padjadjaran; 9; 118–123. doi: 10.24198/jkp.v9i2.1661.
O'Gara, P. T., Kushner, F. G., Ascheim, D. D., Casey, D. E. Jr., Chung, M. K., de Lemos, J. A., Ettinger, S. M., Fang, J. C., Fesmire, F. M., Franklin, B. A., Granger, C. B., Krumholz, H. M., Linderbaum, J. A., Morrow, D. A., Newby, L. K., Ornato, J. P., Ou, N., Radford, M. J., Tamis-Holland, J. E., Tommaso, C. L., Tracy, C. M., Woo, Y. J., Zhao, D. X., Anderson, J. L., Jacobs, A. K., Halperin, J. L., Albert, N. M., Brindis, R. G., Creager, M. A., DeMets, D., Guyton, R. A., Hochman, J. S., Kovacs, R. J., Kushner, F. G., Ohman, E. M., Stevenson, W. G., Yancy, C. W.; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. (2013). 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: a Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation; 127; e362-425. doi: 10.1161/CIR.0b013e3182742cf6.
Oliveira, L. M. S. M, Costa, I. M. N. B. C., Silva, D. G. D., Silva, J. R. S. S., Barreto-Filho, J. A. S., Almeida-Santos, M. A., Oliveira, J. L. M., Buarque, M. D. B. M., Vieira, D. A. D. S., & Sousa, A. C. S. (2019). Readmission of Patients with Acute Coronary Syndrome and Determinants. Arquivos Brasileiros de Cardiologia; 113; 42-49. doi: 10.5935/abc.20190104.
Pocock, S., Brieger, D. B., Owen, R., Chen, J., Cohen, M. G., Goodman, S., Granger, C. B., Nicolau, J. C., Simon, T., Westermann, D., Yasuda, S., Hedman, K., Mellström, C., Andersson Sundell, K., & Grieve, R. (2012). Health-Related Quality of Life 1-3 Years Post-Myocardial Infarction: Its Impact on Prognosis. Open Heart; 8; 1-11. doi: 10.1136/openhrt-2020-001499.
Pramudyo, M., Yahya, A. F., Martanto, E., Tiksnadi, B. B., Karwiky, G., Rafidhinar, R., & Putri, G. N. I. (2022). Predictors of In-Hospital Mortality in Patients with Acute Coronary Syndrome in Hasan Sadikin Hospital, Bandung, Indonesia: A Retrospective Cohort Study. Acta Medica Indonesiana; 54; 379-388.
Pujowaskito, P., Emha, Dinda D. L., Fiddiyanti, I., & Bunawan, R. (2021). Quality of Life Comparison in STEMI Patients with Percutaneous Coronary Intervention (PCI) and Non PCI in Dustira Hospital. Proceedings of the 12th Annual Scientific Meeting, Medical Faculty, Universitas Jenderal Achmad Yani, International Symposium on "Emergency Preparedness and Disaster Response during COVID 19 Pandemic" (ASMC 2021); 266-278. Dordrecht: Atlantis Press. doi: 10.2991/ahsr.k.210723.061.
Qothi, I., Fuadi, M. R., & Subagjo, A. (2021). Profile of Major Risk Factors in Acute Coronary Syndrome (ACS) at Pusat Pelayanan Jantung Terpadu. Cardiovascular Cardiometabolic Journal; 2; 59–72. doi: 10.2473/ccj.v2i2.2021.59-72.
Ramadhan, M., Kusmiran, E., Istianah, I., & Pangestika, D. (2022). Association Between Medication Adherence And Quality Of Life Among Patients With Coronary Artery Disease During Pandemic Covid-19 At Private Hospital Type A Bandung-Indonesia. Jurnal Online Keperawatan Indonesia; 5; 10-17. doi: 10.51544/keperawatan.v5i1.2911.
Rathore, V. (2018). Risk Factors of Acute Myocardial Infarction: A Review. Eurasian Journal of Medical Investigation; 2; 1-7. doi: 10.14744/ejmi.2018.76486.
Romalina, R., Indra, M. R., & Susmarini, D. (2018). Faktor Pasien Berhubungan Dengan Angka Readmission Pada Pelaksanaan Discharge Planning Pasien Acute Coronary Syndrome (Acs). Journal of Health Sciences; 10; 106–119. doi: 10.33086/jhs.v10i1.151.
Rymer, J. A., Chen, A. Y., Thomas, L., Fonarow, G. C., Peterson, E. D., & Wang, T. Y. (2019). Readmissions After Acute Myocardial Infarction: How Often Do Patients Return to the Discharging Hospital?. Journal of the American Heart Association; 8; 1-14. doi: 10.1161/JAHA.119.012059.
Sadrnia, S., Pourmoghaddas, M., Hadizadeh, M., Maghamimehr, A., Esmaeeli, M., Amirpour, A., & Khosravi, A. (2013). Factors Affecting Outcome of Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction. ARYA Atheroscler; 9; 241-6.
Serrano-Rosa, M. Á., León-Zarceño, E., Giglio, C., Boix-Vilella, S., Moreno-Tenas, A., Pamies-Aubalat, L., & Arrarte, V. (2021). Psychological State after an Acute Coronary Syndrome: Impact of Physical Limitations. International Journal of Environmental Research and Public Health; 18; 1-13. doi: 10.3390/ijerph18126473.
Shang, P., Liu, G. G., Zheng, X., Ho, P. M., Hu, S., Li, J., Jiang, Z., Li, X., Bai, X., Gao, Y., Xing, C., Wang, Y., Normand, S. L., & Krumholz, H. M. (2019). Association Between Medication Adherence and 1-Year Major Cardiovascular Adverse Events After Acute Myocardial Infarction in China. Journal of the American Heart Association; 8; 1-15. doi: 10.1161/JAHA.118.011793.
Suhail, M., Saeed, H., Saleem, Z., Younas, S., Hashmi, F. K., Rasool, F., Islam, M., & Imran, I. (2021). Association of Health Literacy and Medication Adherence with Health-Related Quality of Life (HRQoL) in Patients with Ischemic Heart Disease. Health and Quality of Life Outcomes; 19; 1-13. doi: 10.1186/s12955-021-01761-5.
Thomson, P., Rushworth, G. F., Andreis, F. et al. (2020). Longitudinal Study of the Relationship Between Patients’ Medication Adherence and Quality of Life Outcomes and Illness Perceptions and Beliefs about Cardiac Rehabilitation. BMC Cardiovascular Disorders; 20; 1-11. doi: 10.1186/s12872-020-01378-4.
Tripathi, B., Yeh, R. W., Bavishi, C. P., Sardar, P., Atti, V., Mukherjee, D., Bashir, R., Abbott, J. D., Giri, J., & Chatterjee, S. (2019). Etiologies, Trends, and Predictors of Readmission in ST-Elevation Myocardial Infarction Patients Undergoing Multivessel Percutaneous Coronary Intervention. Catheterization and Cardiovascular Interventions: Official journal of the Society for Cardiac Angiography & Interventions; 94; 905–914. doi: 10.1002/ccd.28344.
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Fugar, S., Generoso, G., Heard, D. G., Hiremath, S., Ho, J. E., Kalani, R., … American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2023). Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation; 147; e93–e621. doi: 10.1161/CIR.0000000000001123.
Tsoulou, V., Vasilopoulos, G., Kapadochos, T., Pavlatou, N., Kalogianni, A., Toulia, G., Dousis, E., Panoutsopoulos, G., Kourakos, M., & Polikandrioti, M. (2023). Quality of Life in Patients Undergoing Percutaneous Coronary Intervention. Clinics and Practice; 13; 621–637. doi: 10.3390/clinpract13030057.
Vafaie, M., Hochadel, M., Münzel, T., Hailer, B., Schumacher, B., Heusch, G., Voigtländer, T., Mudra, H., Haude, M., Barth, S., Schmitt, C., Darius, H., Maier, L. S., Katus, H. A., Senges, J., & Giannitsis, E. (2020). Guideline-Adherence Regarding Critical Time Intervals in the German Chest Pain Unit registry. European Heart Journal Acute Cardiovascular Care; 9; 52–61. doi: 10.1177/2048872618762639.
Yusniawati, Yueniwati, Y., & Kartikawatiningsih, D. Knowledge and Socioeconomic Status as the Factors of Pre-Hospital Delay in Patients with Acute Coronary Syndrome. Research Journal of Life Science; 5; 34-41.
Zanchin, C., Ledwoch, S., Bär, S., Ueki, Y., Otsuka, T., Häner, J. D., Zanchin, T., Praz, F., Hunziker, L., Stortecky, S., Pilgrim, T., Losdat, S., Windecker, S., Räber, L., & Siontis, G. C. M. (2022). Acute Coronary Syndromes in Young Patients: Phenotypes, Causes and Clinical Outcomes Following Percutaneous Coronary Interventions. International Journal of Cardiology; 350; 1–8. doi: 10.1016/j.ijcard.2022.01.018.
Zhang, Y., Kaplan, C. M., Baik, S. H., Chang, C. C., & Lave, J. R. (2014). Medication Adherence and Readmission After Myocardial Infarction in the Medicare Population. The American Journal of Managed Care; 20; e498–e505.
Copyright (c) 2025 JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
1. The copyright of this journal belongs to the Editorial Board and Journal Manager with the author's knowledge, while the moral right of the publication belong to the author.
2. The formal legal aspect of journal publication accessibility refers to the Creative Commons Attribution-Non-Commercial-Share Alike (CC BY-NC-SA), which implies that the publication can be used for non-commercial purposes in its original form.
3. Every publication (print/electronic) is open access for educational, research, and library purposes. In addition to the objectives mentioned above, the editorial board is not responsible for copyright infringement