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Systematic reviews: causes of non-adherence to P2Y12 inhibitors in acute coronary syndromes and response to intervention
  1. Nina Johnston1,
  2. John Weinman2,
  3. Lucy Ashworth3,
  4. Peter Smethurst4,
  5. Jad El Khoury4 and
  6. Clare Moloney3
  1. 1Department of Cardiology, UCR-Uppsala Clinical Research Center and Dept. of Medical Sciences, Uppsala University, Uppsala, Sweden
  2. 2Department of Psychology, King's College, London, UK
  3. 3Atlantis Healthcare, London, UK
  4. 4AstraZeneca, Cambridge, UK
  1. Correspondence to Dr Nina Johnston; nina.johnston{at}


To understand the factors associated with non-adherence to oral antiplatelet (OAP) therapy in acute coronary syndromes (ACS), and where interventions have modified these factors. Linked systematic reviews were undertaken in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines, using CINAHL Plus, MEDLINE, PsycINFO and PubMed databases. The searches were limited to studies available in English and published from 2000 onwards; last run in June 2015. Review 1: factors. Fifteen articles were identified that reported 25 different factors associated with OAP non-adherence. Factors were categorised into: Demographic, Treatment, Healthcare System Processes, Clinical, Opportunity (ie, factors outside the patients, such as cost and healthcare access) and Psychosocial. It was not possible to determine if any of these factors were more impactful than others, either overall or temporally. Review 2: interventions. Six articles were identified that described interventions targeting adherence in patients with acute coronary syndromes (ACS)/coronary artery disease (CAD). Four broad categories of intervention were identified: treatment counselling and education, educational materials, SMS reminders and telephone monitoring and reinforcement delivered different practitioners. Only reminder-based interventions had a consistently successful impact on adherence outcomes at both 3 and 12 months. A number of factors are associated with OAP non-adherence, and encouragingly, there is some evidence of the effectiveness of intervention to modify treatment adherence in patients with ACS/CAD. Future evaluations ensuring a better cohesion between the factors studied as associated with non-adherence and those targeted by intervention would further increase understanding and lead to improved results.


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  • Funding This research was funded by AstraZeneca and undertaken by Atlantis Healthcare. PS and JEK are employees of AstraZeneca. NJ has received lecture fees from AstraZeneca for education of healthcare professionals. LA and CM are full-time employees of Atlantis Healthcare, and JW is a part-time employee of Atlantis Healthcare.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.