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Original research article
Adherence to coronary artery disease secondary prevention medicines: exploring modifiable barriers
  1. Rani Khatib1,2,3,
  2. Kay Marshall4,
  3. Jon Silcock5,
  4. Claire Forrest3 and
  5. Alistair S Hall2,3
  1. 1Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
  4. 4School of Health Sciences, University of Manchester, Manchester, UK
  5. 5Bradford School of Pharmacy, University of Bradford, Bradford, UK
  1. Correspondence to Dr Rani Khatib; r.khatib{at}


Background Non-adherence to secondary prevention medicines (SPMs) among patients with coronary artery disease (CAD) remains a challenge in clinical practice. This study attempted to identify actual and potential modifiable barriers to adherence that can be addressed in cardiology clinical practice.

Methods This was a cross-sectional, postal survey-based study of the medicines-taking experience of patients with CAD treated at a secondary/tertiary care centre. All participants had been on SPM for ≥3 months.

Results In total, 696 eligible patients were sent the survey and 503 responded (72.3%). The median age was 70 years, and 403 (80.1%) were male; the median number of individual daily doses of all medicines was 6. The rate of non-adherence to at least one SPM was 43.5% (n=219), but 53.3% of reported non-adherence was to only one SPM. Statins contributed to 66.7% and aspirin to 61.7% of overall non-adherence identified by the Single Question (SQ) tool. In 30.8% of non-adherent patients (n=65), this was at least partly intentional. Barriers included forgetfulness (84.9%; n=186), worry that medicines will do more harm than good (33.8%; n=74), feeling hassled about medicines taking (18.7%; n=41), feeling worse when taking medicines (14.2%; n=31) and not being convinced of the benefit of medicines (9.1%; n=20). In a multivariate analysis, modifiable factors associated with overall non-adherence included being prescribed aspirin (OR: 2.22; 95% CI: 1.18 to 4.17), having specific concern about SPM (OR: 1.12; 95% CI: 1.07 to 1.18) and issues with repeat prescriptions (OR: 2.48; 95% CI: 1.26 to 4.90). Different factors were often associated with intentional versus unintentional non-adherence.

Conclusions Using appropriate self-report tools, patients share actual and potential modifiable barriers to adherence that can be addressed in clinical practice. Non-adherence behaviour was selective. Most non-adherence was driven by forgetfulness, concern about the harm caused by SPM and practical barriers.

  • medicines adherence
  • secondary prevention
  • coronary artery disease

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors The study was led by RK with the support of the supervisors, data collection and administrative support, which included all the coauthors. The design of the study and the questionnaire, and ethics applications were done by RK with the support of KM, JS, ASH. Postage and data collection were with the help of CF. Data analysis was led by RK. All planning and findings were presented to and discussed by the authors. The manuscript was drafted by the lead author and reviewed and adjusted based on suggestions from all the coauthors. All authors gave final approval and agreed to be accountable for all aspects of the work. All revisions were made by the lead author and coauthors reviewed and commented were appropriate.

  • Funding The study was partially funded by the Leeds Teaching Hospitals Charitable Foundation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the NHS Leeds (Central) Research Ethics Committee (reference number 09/H1313/62) and by the University of Bradford Ethics Committee. All patients provided written informed consent to participate.

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

  • Data availability statement All data relevant to the study are included in the article.