Medication adherence and the patient with coronary artery disease: challenges for the practitioner.
OBJECTIVE
Adherence to secondary prevention medications among patients with coronary artery disease is essential in minimizing risks of recurrent myocardial infarction and mortality. Despite its importance, nonadherence remains a significant problem among this population, and a variety of studies have sought to determine its prevalence, contributing factors, and interventions for improvement.


RESULTS
Several recent studies have demonstrated improving rates of adherence over time, though the overall prevalence of nonadherence remains significant. Other studies have identified important factors associated with nonadherence, and two recent trials tested interventions to improve adherence rates.


CONCLUSIONS
Although there have been some improvements in adherence rates, it remains a significant issue. Nonadherence increases both general and cardiac-specific adverse events. Several important factors such as patient attitudes, external influences, concurrent comorbidities, and health system characteristics appear to significantly impact adherence rates. Recent trials to improve adherence rates have demonstrated only modest effects, but lessons from these initial interventions should be incorporated into future strategies to improve adherence.
Maddox
Thomas M
TM
Denver VAMC, USA bUniversity of Colorado, Denver, CO 80220, USA. thomas.maddox@va.gov
Ho
P Michael
PM
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D008076:Cholesterol, HDL / Q000187:drug effects; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000517:prevention & control*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D050171:Dyslipidemias / Q000188:drug therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents; D055118:Medication Adherence; D009203:Myocardial Infarction; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention; D014481:United States / Q000453:epidemiology
D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents