Medication Compliance Among Sehat Sahulat Insured Patients Following Percutaneous Coronary Intervention in a Tertiary Care Hospital of Peshawar
DOI:
https://doi.org/10.52206/jsmc.2026.16.2.1425Abstract
Background: Medication compliance following percutaneous coronary intervention (PCI) is essential for preventing recurrent cardiovascular events and improving long-term outcomes. However, non-compliance remains a major challenge, particularly in low- and middle-income populations where socioeconomic barriers may limit access to long-term therapy.
Objective: To determine medication compliance among Sehat Sahulat insured patients after PCI and evaluate factors associated with medication compliance in a tertiary care hospital in Peshawar.
Methodology: This descriptive cross-sectional study was conducted at the Peshawar Institute of Cardiology from 1st October 2025 to 31st December 2025. A total of 310 patients aged 19–75 years who had undergone PCI within the previous one to three months under the Sehat Sahulat program were recruited through non-probability consecutive sampling. Medication compliance was assessed using the validated 4-item Morisky Medication Compliance Scale (MMAS-4). Demographic and clinical characteristics including age, gender, educational status, socioeconomic status, and family history of coronary artery disease (CAD)/PCI were recorded.
Results: The mean age of participants was 56.70±8.49 years, and most were male (85.16%). Overall medication compliance was observed in only 80 (25.81%) participants, while 230 (74.19%) were non-adherent. Educational status showed a significant association with compliance in univariable analysis (OR=0.52, p=0.02) but lost significance after adjustment (aOR=0.43, p=0.73). Participants in the medium socioeconomic group demonstrated significantly lower odds of compliance in both univariable and multivariable analyses (p<0.001). Family history of PCI/CAD was not independently associated with compliance after adjustment.
Conclusion: Medication compliance among Sehat Sahulat insured patients following PCI was considerably low. Socioeconomic status significantly influenced compliance, highlighting the need for targeted interventions to improve long-term medication compliance and cardiovascular outcomes.
Keywords: Medication compliance, Medication compliance, Percutaneous coronary intervention, Sehat Sahulat Program.
References
Mir MA, Dar MA, Qadir A. Exploring the landscape of coronary artery disease: a comprehensive review. Am J Biomed Pharm. 2024;1:9-22. https://doi.org/10.18433/jpps32140
Tiwari VM, Kumar S. A review on non-communicable disease risk factors and their trends. Emerg Trends Engin. 2022:1-6. https://doi.org/10.1109/icetet-sip-2254415.2022.9791742
Kronenberg F, Mora S, Stroes ES, Ference BA, Arsenault BJ, Berglund L, et al. Lipoprotein (a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022;43(39):3925-46. https://doi.org/10.1093/eurheartj/ehac361
Consortium GCR. Global effect of modifiable risk factors on cardiovascular disease and mortality. New England J Med. 2023;389(14):1273-85. https://doi.org/10.1056/nejmoa2206916
Florek K, Kübler M, Górka M, Kübler P. New modifiable risk factors influencing coronary artery disease severity. Int J Molec Sci. 2024;25(14):7766. https://doi.org/10.3390/ijms25147766
Lindahl B, Mills NL. A new clinical classification of acute myocardial infarction. Nat Med. 2023;29(9):2200-05. https://doi.org/10.1038/s41591-023-02513-2
Hsieh Y-K, Wang M-T, Wang C-Y, Chen C-F, Ko Y-L, Huang W-C. Recent advances in the diagnosis and management of acute myocardial infarction. J Chinese Med Assoc. 2023;86(11):950-59. https://doi.org/10.1097/jcma.0000000000001001
Mobini S, Allahbakhshian A, Shabanloei R, Sarbakhsh P. Illness perception, self-efficacy, and medication compliance in patients with coronary artery disease: a path analysis of conceptual model. SAGE Open Nursing. 2023;9:772. https://doi.org/10.1177/23779608231171772
Son YJ, Kim SH, Park JH. Role of depressive symptoms and self?efficacy of medication compliance in K orean patients after successful percutaneous coronary intervention. Int J Nursing Pract. 2014;20(6):564-72. https://doi.org/10.1111/ijn.12203
Swieczkowski D, Mogielnicki M, Cwalina N, Zuk G, Pisowodzka I, Ciecwierz D, et al. Medication compliance in patients after percutaneous coronary intervention due to acute myocardial infarction: From research to clinical implications. Cardiol J. 2016;23(5):483-90. https://doi.org/10.5603/cj.a2016.0048
Salari A, Balasi LR, Ashouri A, Moaddab F, Zaersabet F, Nourisaeed A. Medication compliance and its related factors in patients undergoing coronary artery angioplasty. J Caring Sci. 2018;7(4):213. https://doi.org/10.15171/jcs.2018.032
Yue Z, Bin W, Weilin Q, Aifang Y. Effect of medication compliance on blood pressure control and risk factors for antihypertensive medication compliance. J Eval Clin Pract. 2015;21(1):166-72. https://doi.org/10.1111/jep.12268
Alomar MJ. Factors affecting the development of adverse drug reactions. Saudi Pharm J. 2014;22(2):83-94. https://doi.org/10.1016/j.jsps.2013.02.003
Rahhal A, Mahfouz A, Khir F, Okleh N, Aljundi AH, AlKhalaila O, et al. Medications compliance post-primary percutaneous coronary intervention in acute myocardial infarction: A population-based cohort study. J Clin Pharm Ther. 2021;46(3):772-9. https://doi.org/10.1111/jcpt.13348
Dodani S, Mistry R, Khwaja A, Farooqi M, Qureshi R, Kazmi K. Prevalence and awareness of risk factors and behaviours of coronary heart disease in an urban population of Karachi, the largest city of Pakistan: a community survey. J Public Health. 2004;26(3):245-9. https://doi.org/10.1093/pubmed/fdh154
Saqlain M, Riaz A, Malik MN, Khan S, Ahmed A, Kamran S, et al. Medication compliance and its association with health literacy and performance in activities of daily livings among elderly hypertensive patients in Islamabad, Pakistan. Med. 2019;55(5):163-69. https://doi.org/10.3390/medicina55050163
Yap AF, Thirumoorthy T, Kwan YH. Medication compliance in the elderly. J Clin Gerontol Geriatr. 2016;7(2):64-7. https://doi.org/10.1016/j.jcgg.2015.05.001
Dhaliwal KK, King-Shier K, Manns BJ, Hemmelgarn BR, Stone JA, Campbell DJ. Exploring the impact of financial barriers on secondary prevention of heart disease. BMC Cardiovasc Disord. 2017;17(1):1-8. https://doi.org/10.1186/s12872-017-0495-4
Deng Y-p, Xie W, Liu T, Wang S-y, Wang M-r, Zan Y-x, et al. Association of Hypertension with Severity and Mortality in Hospitalized Patients with COVID-19 in Wuhan, China: a single-centered, retrospective study. Arquivos Brasileiros de Cardiologia. 2021;117:911-21. https://doi.org/10.20945/2359-3997000000384
Carr JJ, Jacobs DR, Terry JG, Shay CM, Sidney S, Liu K, et al. Association of coronary artery calcium in adults aged 32 to 46 years with incident coronary heart disease and death. JAMA Cardiol. 2017;2(4):391-9. https://doi.org/10.1001/jamacardio.2016.5493
Varenne O, Cook S, Sideris G, Kedev S, Cuisset T, Carrié D, et al. Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial. Lancet. 2018;391(10115):41-50. https://doi.org/10.1016/s0140-6736(17)32713-7
Rodgers JL, Jones J, Bolleddu SI, Vanthenapalli S, Rodgers LE, Shah K, et al. Cardiovascular risks associated with gender and aging. J Cardiovasc Dev Dis. 2019;6(2):19-27. https://doi.org/10.3390/jcdd6020019
Hou Y, Yue Y, Zhao M, Jiang S. Prevalence and association of medication noncompliance with major adverse cardiovascular events in patients with myocardial infarction. Med. 2019;98(44):141-48. https://doi.org/10.1097/md.0000000000017826
Thakur JS, Vijayvergiya R, Jaswal N, Ginsburg A. Assessment and barriers to medication compliance for secondary prevention of cardiovascular disease among patients with coronary artery disease in Chandigarh, India. Int J Noncommun Dis. 2016;1(1):37-41. https://doi.org/10.4103/2468-8827.184863
Additional Files
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 The authors retain the copyrights. Authors are permitted and encouraged to post their work online (e.g. in institutional repositories or on their website), as it can lead to productive exchanges, as well as greater citation of published work.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purpose. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
