Iran Journal of Nursing

Introduction
The prevalence of cardiovascular diseases (CVD) has been increasing. They are the leading cause of death in the world. In Iran, CVDs have been the most important cause of death in the last two decades, and it is expected that they will account for 44.8% of death cases in Iran by 2030. The most common CVDs is coronary artery disease (CAD), which is mainly characterized by the narrowing or blockage of the coronary arteries due to atherosclerosis. There are some methods to treat CAD, including coronary artery bypass graft, coronary angioplasty, and drug therapy. After having coronary angioplasty, patients often worry about changes in their lifestyle, lack of self-care knowledge (activity level, diet, medications, and the drug side effects), and lack of awareness about the methods that can improve their self-care skills. This indicates the need to measure their treatment adherence. To assess the risk of CVDs, a diagnostic tool is needed to identify people at risk. One of the available and common tools is the Framingham risk score (FRS). Treatment adherence is the main concern of physicians and nurses, especially in patients with heart disease who needs adhere to the prescribed treatment for a long time. This study aims to determine the relationship between treatment adherence and the risk of CVDs in patients with CAD. 

Methods
This is a descriptive cross-sectional study conducted from June to August 2021. The study population includes all male and female patients with coronary artery stents referred to Shahid Madani Hospital in Tabriz, Iran. Of these, 200 were randomly selected for the study. Inclusion criteria were having coronary stent, at least three months of stent placement. The exclusion criteria were unwillingness to continue participating in the study, being unavailable (change of location), or death. The data collection tools included a demographic form, treatment adherence questionnaire, and FRS. The data analysis was performed in SPSS software, version 22.

Results
The mean age of the patients was 61.6±10.62. The majority of them were male (60.5%) and all of them had a history of re-hospitalization. The overall mean score of treatment adherence was 41.50±8.48, indicating moderate adherence. In terms of diet and regular physical activity, patients’ adherence was poor. The mean FRS was 19.50±4.84 for women and 14.35±3.88 for for men. Overall, there was a significant relationship between treatment adherence and the risk of CVDs in patients, such that the risk of CVDs in the next 10 years among patients decreases with increasing their adherence to treatment (r=-0.25, P<0.001).

Conclusion
The treatment adherence of patients with coronary artery stents in Tabriz, Iran is at a moderate level. Their poor treatment adherence was in high fat consumption and regular exercise. Male patients (about 16%) with coronary artery stents are twice more than women (about 8%) at risk of CVDs in the next ten years. There is a significant relationship between treatment adherence and the risk of CVDs in these patients.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Tabriz University of Medical Sciences (Code: IR.TBZMED.REC.1399.1027).

Funding
This research was funded by Tabriz University of Medical Sciences (Grant No.: 65875)

Authors' contributions
Study Design: Leila Ahmadi and Hamidreza Haririan; Data Gathering: Leila Ahmadi; Data Analysis: Leila Ahmadi, Hamidreza Haririan, Hadi Hassankhani; Article Writing: Hamidreza Haririan. 

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all the patients who participated in this study for their cooperation.


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