Improving adherence to medication for secondary cardiovascular disease prevention.

Survivors of myocardial infarction are at risk of recurrent events and have an annual death rate of 5%. Advances in treatment and, in particular, the interventional management of myocardial infarction have seen important mortality gains over recent decades, yet cardiovascular diseases remain the biggest killer in many European countries. Change in lifestyle and adherence to medication to prevent further events are key to the recurrence of future events following myocardial infarction, but adherence to medication for the secondary prevention of cardiovascular disease is a profound problem. This article outlines a growing evidence base about the complex nature of adherence as a psychological phenomenon that is influenced by the nature of the event itself, illness perception and factors related to medication beliefs that cannot be addressed simply through a combination of educational approaches. A whole-systems approach is advocated, starting with the education of health professionals to understand the psychology of adherence, and to react comfortably to patients decisions about medication, with a pivotal role for follow-up in secondary care and cardiac rehabilitation.

Evidence of poor adherence to secondary prevention after acute coronary syndromes: possible remedies through the application of new technologies.

Adherence to secondary prevention medications following acute coronary syndrome (ACS) is disappointingly low, standing around 40-75% by various estimates. This is an inefficient use of the resources devoted to their development and implementation, and also puts patients at higher risk of poor outcomes post-ACS. Numerous factors contribute to low adherence including poor motivation, forgetfulness, lack of education about medications, complicated polypharmacy of ACS regimens, (fear of) adverse side effects and limited practical support. Using technology to improve adherence in ACS is an emerging strategy and has the potential to address many of the above factors-computer-based education and mobile phone reminders are among the interventions trialled and appear to improve adherence in patients with ACS. As we move into an increasingly technological future, there is potential to use devices such as smartphones and tablets to encourage patient responsibility for medications. These handheld technologies have great scope for allowing patients to view online medical records, education modules and reminder systems, and although research specific to ACS is limited, they have shown initial promise in terms of uptake and improved adherence among similar patient populations. Given the overwhelming enthusiasm for handheld technologies, it would seem timely to further investigate their role in improving ACS medication adherence.