The relationship between beliefs, expectations, and adherence to therapy during the COVID-19 period: a multi-group cohort study on patients with Ischemic Heart Disease (IHD)

Introduction: The COVID-19 pandemic, starting in March 2020, drastically altered healthcare, leading to reduced services and hospital suspensions due to increased admissions. Fear of infection decreased hospital visits, emphasizing the need for cautious resumption of services. Patients with Ischemic Heart Disease (IHD) face added stress during this transition, as adherence to long-term therapy is crucial for preventing recurrent events, compounded by pandemic-related anxiety and depression potentially hindering treatment engagement. Decision-making in medical care, influenced by past experiences and knowledge, warrants further exploration regarding expectations' role in therapy adherence. Methods: A mixed-methods multi-group cohort study was conducted involving patients with IHD during the transition from COVID-19. In addition to collecting socio-demographic, lifestyle, and clinical information, data related to follow-up visits, number of hospitalizations in the last year, therapy adherence using the Medication Adherence Rating Scale (MARS), the difference between pills taken and prescribed, and Net Adverse Clinical Events (NACE) were considered. Semi-structured interviews based on Interpretative Phenomenological Analysis (IPA) were administered to better understand subjective experiences, along with the following psychological scales: Coronavirus Anxiety Scale (CAS); Covid-19 Stress Scale (CSS); Brief Illness Perception Questionnaire (BIPQ); Illness Cognition Questionnaire (ICQ); Hospital Anxiety and Depression Scale (HADS). Additionally, questions were asked about illness expectations. Data were collected at baseline, 3, 6 and 12 months. Results: Since June 2022 to date, 200 participants (78.5% male) with a mean age of 63.8 (SD=10.4) have been recruited from three centres, two of which are for acute care and one for rehabilitation. Currently, the established connection between post-hospitalization anxiety and illness perception indicates that elevated anxiety levels correlate with a heightened sense of illness threat. Additionally, there's an observed trend where illness threat perception is more pronounced in the initial phases following a cardiac event, gradually diminishing over time during the post-hospitalization period, thereby impacting patients' expectations. Discussion: Better understanding patients' experiences and perceptions during the transition from COVID-19, which can inform tailored interventions to improve therapy adherence and mental health support. Additionally, identifying factors associated with adherence, such as illness perceptions and anxiety levels, could aid in developing targeted strategies to optimize patient care and outcomes.