Lifestyle Behaviours and Antiplatelet Medication Adherence Among Post-Percutaneous Coronary Intervention Patients in Saudi Arabia: Implications for Holistic Cardiovascular Nursing Care

Abstract

Background: Lifestyle behaviours and medication adherence are interrelated components of cardiovascular secondary prevention, yet their co-occurrence in Middle Eastern post-percutaneous coronary intervention (PCI) populations remains poorly characterised. This study described smoking status and physical activity patterns, assessed antiplatelet medication adherence, and explored associations between lifestyle factors and adherence among Saudi patients following PCI. Methods: A cross-sectional survey was conducted among 236 Saudi adults who had undergone PCI within the preceding 12 months at two tertiary cardiac centres in Riyadh, Saudi Arabia. Data were collected on smoking status, cigarette consumption, self-reported physical activity frequency (defined as the frequency of engagement in regular exercise such as walking, swimming, or other structured physical activity), and self-reported medication adherence measured via the Morisky Medication Adherence Scale-8 (MMAS-8). Descriptive statistics characterised lifestyle and adherence patterns. Bivariate analyses (chi-square tests) and multivariate binary logistic regression were used to explore associations between lifestyle factors and adherence, adjusting for comorbidities including hypertension, diabetes mellitus, arthritis, and heart disease. Results: Participants were predominantly male (73.7%) and older adults (83.9% aged >50 years). Smoking prevalence was 23.3% (n = 55 of 236 participants), and physical inactivity was highly prevalent, with 57.2% of the sample (n = 135) reporting never engaging in regular exercise. Adherence was suboptimal, with 55.4% of participants (n = 129) classified as having low adherence (self-reported, measured via the MMAS-8). In multivariate analysis, arthritis was the only statistically significant predictor of adherence (adjusted odds ratio [AOR] = 2.81, 95% confidence interval [CI]: 1.01–7.84, p = 0.048; note, however, that this finding does not survive Bonferroni correction for multiple comparisons and should be interpreted as hypothesis-generating). Smoking (AOR = 0.52, 95% CI: 0.19–1.45, p = 0.213) and physical inactivity (AOR = 0.45, 95% CI: 0.09–2.25, p = 0.332) showed inverse but statistically non-significant trends with adherence. Conclusions: Unhealthy lifestyle behaviours and low medication adherence were each highly prevalent and co-occurred in this post-PCI population, though associations between lifestyle factors and adherence were not statistically confirmed except for arthritis. These descriptive findings are hypothesis-generating and provide a rationale for future adequately powered prospective studies and trials evaluating integrated nursing interventions that simultaneously address smoking, physical inactivity, and medication non-adherence in Saudi cardiac care settings.