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Medication adherence and the patient with coronary artery disease: challenges for the practitioner
Thomas M Maddox1, P Michael Ho
1Denver VAMC, USA bUniversity of Colorado, Denver, CO 80220, USA. thomas.maddox@va.gov
Insights
Medication adherence for coronary artery disease patients is crucial for preventing heart attacks and death. While adherence is improving, nonadherence remains a significant issue impacting patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Secondary prevention medications are vital for patients with coronary artery disease (CAD) to reduce risks of recurrent myocardial infarction (MI) and mortality.
- Nonadherence to these essential medications is a persistent challenge in this high-risk population.
- Understanding the prevalence, contributing factors, and effective interventions for medication adherence in CAD is critical.
Purpose of the Study:
- To review recent studies on medication adherence in patients with coronary artery disease.
- To identify current prevalence rates, contributing factors, and tested interventions for nonadherence.
- To synthesize findings and inform future strategies for improving adherence.
Main Methods:
- Systematic review of recent literature on medication adherence in CAD.
- Analysis of studies reporting prevalence, risk factors, and intervention outcomes.
- Synthesis of findings from clinical trials and observational studies.
Main Results:
- Recent studies indicate some improvement in adherence rates over time, but overall nonadherence remains substantial.
- Key factors influencing nonadherence include patient attitudes, external influences, comorbidities, and health system characteristics.
- Intervention trials have shown only modest effects on improving adherence rates.
Conclusions:
- Despite improvements, medication nonadherence in CAD patients continues to be a significant clinical problem, increasing adverse events.
- Addressing multifaceted factors like patient beliefs, social determinants, and healthcare system issues is essential for enhancing adherence.
- Future strategies should integrate lessons from recent trials to develop more effective interventions for improving secondary prevention medication adherence.
Purpose Of Review:
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.
Recent Findings:
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.
Summary:
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.
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