title: Adherence to therapies for secondary prevention of cardiovascular disease: a focus on aspirin.
abstract: OBJECTIVE
  Suboptimal adherence to medications taken chronically for secondary prevention of cardiovascular disease (CVD, e.g., aspirin) continues to burden the healthcare system despite the well-established benefits of prevention. We conducted a literature search to examine patient adherence to medications for secondary prevention of CVD-as evaluated by prescription refill data, electronic medication monitors, pill counts, and physiologic markers-to better identify an unmet need for measures to improve patient adherence to these therapies.
  
  
  METHODS
  English-language articles were obtained from the PubMed database using the following key words or combinations thereof "adherence," "compliance," "secondary prevention," and "cardiovascular disease." Publications that provided adherence data only for primary prevention, lacked data on medication adherence (e.g., focus on guideline adherence), emphasized quality-of-care outcomes, or focused on outcomes of acute interventions were excluded.
  
  
  RESULTS
  Multiple patient-, disease-, and treatment-related factors may contribute to poor adherence to treatment regimens, and therefore, a multifactorial approach will likely be needed to improve compliance with prescribed treatments for CVD. Although no magic bullet exists to assure full adherence, adherence programs coupled with patient counseling and education (inclusive of over-the-counter therapies), along with treatments that are less complex or avoid bothersome adverse effects, are more likely to be associated with successful outcomes.
  
  
  CONCLUSIONS
  Given the burden of CVD to the community and the healthcare system, nonadherence to CVD-preventative medications such as aspirin remains a substantial area of unmet need and represents a key opportunity for the development of quality-of-care enhancement programs to improve health outcomes in this patient population.
authors.affiliation: Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Packard
authors.affiliation: Department of Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA.|The Cardiac Center of Creighton University School of Medicine, Omaha, NE, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Hilleman
mesh_terms: D001241:Aspirin / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D055118:Medication Adherence; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D001241:Aspirin
keywords: adherence; aspirin; cardiovascular disease; diabetes mellitus; morbidity and mortality; over-the-counter