title: Medication taking in coronary artery disease: a systematic review and qualitative synthesis.
abstract: OBJECTIVE
  Despite the compelling evidence supporting cardiovascular medications in the secondary prevention of coronary artery disease, many patients discontinue treatment. In this synthesis, we sought to understand from a patient perspective the factors that promote medication persistence.
  
  
  METHODS
  We systematically searched 7 databases (MEDLINE, Embase, PsycINFO, SCOPUS, CINAHL, ASSIA, and SSCI) for published qualitative research about the medication-taking experiences of patients with coronary artery disease and their partners. Articles were assessed for quality using a modified CASP (Critical Appraisal Skills Programme) checklist. Synthesis was undertaken using well-established meta-ethnographic approaches.
  
  
  RESULTS
  We included 17 articles in the final synthesis from the United Kingdom (6), Europe (5), United States (4), China (1), and Australia (1), with a total sample size of 391 patients. Analyses suggested that some patients hold fatalistic beliefs about their disease, whereas others believe they have been cured by interventions; both can lead to failure to take medication. Patients who adapt to being a "heart patient" are positive about medication taking. Some individuals dislike taking tablets generally and are wary of long-term effects. Relationships with prescribing clinicians are of critical importance for patients, with inaccessibility and insensitive terminology negatively affecting patients' perceptions about treatments.
  
  
  CONCLUSIONS
  Strategies to promote higher persistence of secondary prevention medications in patients with coronary artery disease need to recognize the key role of the prescribing clinician. Providing medication-specific information at the time of initiating therapy, improving the transition between secondary and primary care, and explaining the risk of disease recurrence may all help to modify patient attitudes toward drugs to prevent further cardiovascular disease.
authors.affiliation: The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Rashid
authors.forename: Duncan
authors.initials: D
authors.lastname: Edwards
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Walter
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
mesh_terms: D001294:Attitude to Health; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055118:Medication Adherence / Q000523:psychology; D010817:Physician-Patient Relations; D055502:Secondary Prevention; D016903:Drug Monitoring
keywords: adherence; compliance; coronary artery disease; drug therapy; heart disease; medication; patient behavior; persistence; qualitative research; secondary prevention