title: A polypill strategy to improve adherence: results from the FOCUS project. Improving Adherence to Medication in Stroke Survivors: A Pilot Randomised Controlled Trial Effects of a fixed-dose combination strategy on adherence and risk factors in patients with or at high risk of CVD: the UMPIRE randomized clinical trial. Full Prescription Coverage Versus Usual Prescription Coverage After Coronary Artery Bypass Graft Surgery: Analysis From the Post-Myocardial Infarction Free Rx Event and Economic Evaluation (FREEE) Randomized Trial Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey A pragmatic randomized trial of a polypill-based strategy to improve use of indicated preventive treatments in people at high cardiovascular disease risk Does behaviour modification affect post-stroke risk factor control? Three-year follow-up of a randomized controlled trial Blood pressure 1 year after stroke: the need to optimize secondary prevention. Cardiovascular risk assessment and treatment to target low density lipoprotein levels in hospitalized ischemic heart disease patients: results of the HOLEM study. Statin initiation following coronary artery bypass grafting: outcome of a hospital discharge protocol. Full coverage for preventive medications after myocardial infarction. Being Well-Informed About Statin is Associated with Continuous Adherence and Reaching Targets Impact of pharmacy counseling on compliance and effectiveness of combination lipid-lowering therapy in patients undergoing coronary artery revascularization: a randomized, controlled trial. Standardized discharge orders after stroke: Results of the quality improvement in stroke prevention (QUISP) cluster randomized trial
abstract: BACKGROUND Adherence to evidence -based cardiovascular ( CV ) medications after an acute myocardial infa rct ion ( MI ) is low after the first 6 months . The use of fixed-dose combinations ( FDC ) has been shown to improve treatment adherence and risk factor control . However , no previous r and omized trial has analyzed the impact of a polypill strategy on adherence in post-MI patients . OBJECTIVES The cross-sectional FOCUS ( Fixed-Dose Combination Drug for Secondary Cardiovascular Prevention ) study ( Phase 1 ) aim ed to eluci date factors that interfere with appropriate adherence to CV medications for secondary prevention after an acute MI . Additionally , 695 patients from Phase 1 were r and omized into a controlled trial ( Phase 2 ) to test the effect of a polypill ( containing aspirin 100 mg , simvastatin 40 mg , and ramipril 2.5 , 5 , or 10 mg ) compared with the 3 drugs given separately on adherence , blood pressure , and low-density lipoprotein cholesterol , as well as safety and tolerability over a period of 9 months of follow-up . METHODS In Phase 1 , a 5-country cohort of 2,118 patients was analyzed . Patients were r and omized to either the polypill or 3 drugs separately for Phase 2 . Primary endpoint was adherence to the treatment measured at the final visit by the self-reported Morisky-Green question naire ( MAQ ) and pill count ( patients had to meet both criteria for adherence at the in-person visit to be considered adherent ) . RESULTS In Phase 1 , overall CV medication adherence , defined as an MAQ score of 20 , was 45.5 % . In a multivariable regression model , the risk of being nonadherent ( MAQ < 20 ) was associated with younger age , depression , being on a complex medication regimen , poorer health insurance coverage , and a lower level of social support , with consistent findings across countries . In Phase 2 , the polypill group showed improved adherence compared with the group receiving separate medications after 9 months of follow-up : 50.8 % versus 41 % ( p = 0.019 ; intention-to-treat population ) and 65.7 % versus 55.7 % ( p = 0.012 ; per protocol population ) when using the primary endpoint , attending the final visit with MAQ = 20 and high pill count ( 80 % to 110 % ) combined , to assess adherence . Adherence also was higher in the FDC group when measured by MAQ alone ( 68 % vs. 59 % , p = 0.049 ) . No treatment difference was found at follow-up in mean systolic blood pressure ( 129.6 mm Hg vs. 128.6 mm Hg ) , mean low-density lipoprotein cholesterol levels ( 89.9 mg/dl vs. 91.7 mg/dl ) , serious adverse events ( 23 vs. 21 ) , or death ( 1 , 0.3 % in each group ) . CONCLUSIONS For secondary prevention following acute MI , younger age , depression , and a complex drug treatment plan are associated with lower medication adherence . Meanwhile , adherence is increased in patients with higher insurance coverage levels and social support . Compared with the 3 drugs given separately , the use of a polypill strategy met the primary endpoint for adherence for secondary prevention following an acute MI . ( Fixed Dose Combination Drug [ Polypill ] for Secondary Cardiovascular Prevention [ FOCUS ] ; NCT01321255 ) Background Adherence to preventive medication is often poor , and current interventions have had limited success . Purpose This study was conducted to pilot a r and omised controlled trial aim ed at increasing adherence to preventive medication  in stroke survivors using a brief , personalised intervention . Methods Sixty-two stroke survivors were r and omly allocated to either a two-session intervention aim ed at increasing adherence via ( a ) introducing a plan linked to environmental cues ( implementation intentions ) to help establish a better medication-taking routine ( habit ) and ( b ) eliciting and modifying any mistaken patient beliefs regarding medication/stroke or a control group . Primary outcome was adherence to antihypertensive medication  measured objective ly over 3 months using an electronic pill bottle . Results Fifty-eight people used the pill bottle and were analysed as allocated ; 54 completed treatment . The intervention result ed in 10 % more doses taken on schedule ( intervention , 97 % ; control , 87 % ; 95 % CI for difference ( 0.2 , 16.2 ) ; p = 0.048 ) . Conclusions A simple , brief intervention increased medication adherence in stroke survivors , over and above any effect of increased patient contact or mere measurement . ( http://controlled-trials.com , number IS RCT N38274953 . IMPORTANCE Most patients with cardiovascular disease ( CVD ) do not take recommended medications long-term . The use of fixed-dose combinations ( FDCs ) improves adherence in several clinical areas . Previous trials of cardiovascular FDCs have assessed short-term effects compared with placebo or no treatment . OBJECTIVE To assess whether FDC delivery of aspirin , statin , and 2 blood pressure-lowering agents vs usual care improves long-term adherence to indicated therapy and 2 major CVD risk factors , systolic blood pressure ( SBP ) and low-density lipoprotein cholesterol ( LDL-C ) . DESIGN , SETTING , AND PARTICIPANTS The UMPIRE trial , a r and omized , open-label , blinded-end-point trial among 2004 participants with established CVD or at risk of CVD enrolled July 2010-July 2011 in India and Europe . The trial follow-up concluded in July 2012 . INTERVENTIONS Participants were r and omly assigned ( 1:1 ) to an FDC-based strategy  ( n=1002 ) containing either ( 1 ) 75 mg aspirin , 40 mg simvastatin , 10 mg lisinopril , and 50 mg atenolol or ( 2 ) 75 mg aspirin , 40 mg simvastatin , 10 mg lisinopril , and 12.5 mg hydrochlorothiazide or to usual care ( n=1002 ) . MAIN OUTCOMES AND MEASURES Adherence to medication ( defined as self-reported use of antiplatelet , statin , and ≥2 BP-lowering medications ) and changes in SBP and LDL-C from baseline . RESULTS At baseline , mean BP was 137/78 mm Hg , LDL-C was 91.5 mg/dL , and 1233 ( 61.5 % ) of 2004 participants reported use of antiplatelet , statin , and 2 or more BP-lowering medications . Median follow-up was 15 months ( interquartile range , 12 - 18 months ) . The FDC group had improved adherence vs usual care ( 86 % vs 65 % ; relative risk [ RR ] of being adherent , 1.33 ; 95 % CI , 1.26 - 1.41 ; P < .001 ) with concurrent reductions in SBP ( -2.6 mm Hg ; 95 % CI , -4.0 to -1.1 mm Hg ; P < .001 ) and LDL-C ( -4.2 mg/dL ; 95 % CI , -6.6 to -1.9 mg/dL ; P < .001 ) at the end of the study . Although there was consistency of effects across predefined subgroups , evidence existed of larger benefits in patients with lower adherence at baseline . In this subgroup of 727 participants ( 36 % ) , adherence at the end of study was 77 % vs 23 % ( RR , 3.35 ; 95 % CI , 2.74 - 4.09 ; P < .001 for interaction ) , SBP was reduced by 4.9 mm Hg ( 95 % CI 7.3 - 2.6 mm Hg ; P = .01 for interaction ) , and LDL-C was reduced by 6.7 mg/dL ( 95 % CI , 10.5 - 2.8 mg/dL ; P = .11 for interaction ) . There were no significant differences in serious adverse events or cardiovascular events ( 50 [ 5 % ] in the FDC group and 35 [ 3.5 % ] in the usual care group ; RR , 1.45 ; 95 % CI , 0.94 - 2.24 ; P=.09 ) between the groups . CONCLUSIONS AND RELEVANCE Among patients with or at high risk of CVD , use of an FDC strategy for blood pressure , cholesterol , and platelet control vs usual care result ed in significantly improved medication adherence at 15 months and statistically significant but small improvements in SBP and LDL-C. TRIAL REGISTRATION clinical trials.gov Identifier : NCT01057537 Background — Eliminating out-of-pocket costs for patients after myocardial infa rct ion ( MI ) improves adherence to preventive therapies and reduces clinical events . Because adherence to medical therapy is low among patients treated with coronary artery bypass graft surgery ( CABG ) , we evaluated the impact of providing full prescription coverage to this patient subgroup . Methods and Results — The MI Free Rx Event and Economic Evaluation ( FREEE ) trial r and omly assigned 5855 patients with MI to full prescription coverage or usual formulary coverage for all statins , & bgr;-blockers , angiotensin-converting enzyme inhibitors , or angiotensin receptor blockers . We assessed the impact of full prescription coverage on adherence , clinical outcomes , and healthcare costs using adjusted models among the 1052 patients who underwent CABG at the index hospitalization and 4803 who did not . CABG patients were older and had more comorbid illness ( P<0.01 ) . After MI , CABG patients were significantly more likely to receive & bgr;-blockers and statins but were less likely to receive angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy ( P<0.01 ) . Receiving full drug coverage increased rates of adherence to all preventative medications after CABG ( all P<0.05 ) . Full coverage was also associated with nonsignificant reductions in the rate of major vascular events or revascularization for patients treated with CABG ( hazard ratio , 0.91 ; 95 % confidence interval , 0.66–1.25 ) or without CABG ( hazard ratio , 0.93 ; 95 % confidence interval , 0.82–1.06 ) , with no interaction noted ( Pint = NS ) . After CABG , full prescription coverage significantly reduced patient out-of-pocket spending for drugs ( P=0.001 ) without increasing overall health expenditures ( P = NS ) . Conclusions — Eliminating drug copayments after MI provides consistent benefits to patients treated with or without CABG , leading to increased medication adherence , trends toward improved clinical outcomes , and reduced patient out-of-pocket expenses BACKGROUND Although most cardiovascular disease occurs in low-income and middle-income countries , little is known about the use of effective secondary prevention medications in these communities . We aim ed to assess use of proven effective secondary preventive drugs ( antiplatelet drugs , β blockers , angiotensin-converting-enzyme [ ACE ] inhibitors or angiotensin-receptor blockers [ ARBs ] , and statins ) in individuals with a history of coronary heart disease or stroke . METHODS In the Prospect i ve Urban Rural Epidemiological ( PURE ) study , we recruited individuals aged 35 - 70 years from rural and urban communities in countries at various stages of economic development . We assessed rates of previous cardiovascular disease ( coronary heart disease or stroke ) and use of proven effective  secondary preventive drugs  and blood-pressure-lowering drugs with st and ardised question naires , which were completed by telephone interviews , household visits , or on patient 's presentation to clinics . We report estimates of drug use at national , community , and individual levels . FINDINGS We enrolled 153,996 adults from 628 urban and rural communities in countries with incomes classified as high ( three countries ) , upper-middle ( seven ) , lower-middle ( three ) , or low ( four ) between January , 2003 , and December , 2009 . 5650 participants had a self-reported coronary heart disease event ( median 5·0 years previously [ IQR 2·0 - 10·0 ] ) and 2292 had stroke ( 4·0 years previously [ 2·0 - 8·0 ] ) . Overall , few individuals with cardiovascular disease took antiplatelet drugs  ( 25·3 % ) , β blockers ( 17·4 % ) , ACE inhibitors or ARBs ( 19·5 % ) , or statins ( 14·6 % ) . Use was highest in high-income countries ( antiplatelet drugs 62·0 % , β blockers 40·0 % , ACE inhibitors or ARBs 49·8 % , and statins 66·5 % ) , lowest in low-income countries ( 8·8 % , 9·7 % , 5·2 % , and 3·3 % , respectively ) , and decreased in line with reduction of country economic status ( p(trend)<0·0001 for every drug type ) . Fewest patients received no drugs in high-income countries ( 11·2 % ) , compared with 45·1 % in upper middle-income countries , 69·3 % in lower middle-income countries , and 80·2 % in low-income countries . Drug use was higher in urban than rural areas ( antiplatelet drugs 28·7 % urban vs 21·3 % rural , β blockers 23·5%vs 15·6 % , ACE inhibitors or ARBs 22·8%vs 15·5 % , and statins 19·9%vs 11·6 % ; all p<0·0001 ) , with greatest variation in poorest countries ( p(interaction)<0·0001 for urban vs rural differences by country economic status ) . Country-level factors ( eg , economic status ) affected rates of drug use more than did individual-level factors ( eg , age , sex , education , smoking status , body-mass index , and hypertension and diabetes statuses ) . INTERPRETATION Because use of secondary prevention medications is low worldwide-especially in low-income countries and rural areas - systematic approaches are needed to improve the long-term use of basic , inexpensive , and effective drugs . FUNDING Full funding sources listed at end of paper ( see Acknowledgments ) Background Most individuals at high cardiovascular disease ( CVD ) risk worldwide do not receive any or optimal preventive drugs . We aim ed to determine whether fixed dose combinations of generic drugs ( ‘ polypills ’ ) would promote use of such medications . Methods We conducted a r and omized , open-label trial involving 623 participants from Australian general practice s. Participants had established CVD or an estimated five-year CVD risk of ≥15 % , with indications for antiplatelet , statin and ≥2 blood pressure lowering drugs ( ‘ combination treatment ’ ) . Participants r and omized to the ‘ polypill-based strategy ’  received a polypill containing aspirin 75 mg , simvastatin 40 mg , lisinopril 10 mg and either atenolol 50 mg or hydrochlorothiazide 12.5 mg . Participants r and omized to ‘ usual care ’ continued with separate medications and doses as prescribed by their doctor . Primary outcomes were self-reported combination treatment use , systolic blood pressure and total cholesterol . Results After a median of 18 months , the polypill-based strategy was associated with greater use of combination treatment ( 70 % vs. 47 % ; relative risk 1.49 , ( 95 % confidence interval ( CI ) 1.30 to 1.72 ) p < 0.0001 ; number needed to treat = 4.4 ( 3.3 to 6.6 ) ) without differences in systolic blood pressure ( −1.5 mmHg ( 95 % CI −4.0 to 1.0 ) p = 0.24 ) or total cholesterol ( 0.08 mmol/l ( 95 % CI −0.06 to 0.22 ) p = 0.26 ) . At study end , 17 % and 67 % of participants in polypill and usual care groups , respectively , were taking  atorvastatin  or rosuvastatin . Conclusion Provision of a polypill improved self-reported use of indicated preventive treatments . The lack of differences in blood pressure and cholesterol may reflect limited study power , although for cholesterol , improved statin use in the polypill group counter-balanced use of more potent statins with usual care Objective : Little is known about the long-term effectiveness after stroke of interventions for behaviour modification and ensuring concordance with therapies . We describe a follow-up study of a previous r and omized controlled trial of a brief period of behaviour modification . The aim of this study was to determine outcomes three years after the initial intervention . Design : Survivors of the original cohort were contacted and asked to attend for follow-up interview , within a geriatric day hospital . This study was carried out in the Geriatric Day Hospital at Stobhill Hospital , Balornock Road , Glasgow . Interventions : Details of risk factor control , including blood pressure , cholesterol levels and diabetic control , were assessed . Question naires used in the initial study were repeated including the Geriatric Depression Scale score , Euroqol Perceived Health Status and Stroke Services Satisfaction Question naire . Main measures : Primary outcome was collective risk factor control . Clinical outcomes including recurrent cerebrovascular events , medication persistence and perceived health status were also recorded . Results : Mean length of follow-up was 3.6 years ( SD 0.43 ) . Of the 205 patients enrolled in the initial study , 102 patients attended for repeat interview ( 49 intervention/53 control ) . There were no significant differences in the percentage of controlled risk factors between groups ( intervention 51.7 % versus control 55.9 % , P = 0.53 ) . Similarities were observed in the number of recurrent clinical events and medication persistence between groups . No overall difference was observed in perceived health status , satisfaction with care or depression scores . Conclusions : Brief intervention with respect to behaviour modification and risk factor control does not appear to have any long-term benefit . These results must be cautiously interpreted in light of the small study number and further research is required Lowering blood pressure ( BP ) in stroke survivors reduces the risk of recurrent stroke . We tested the hypothesis that a nurse-led nonpharmacologic intervention would lower the BP of participants in an intervention group compared with a control group . A total of 349 patients who had sustained acute stroke or transient ischemic attack were r and omly assigned to either usual care or to 4 home visits by a nurse . During the visits , the nurse measured and recorded BP and provided individually tailored counseling on a healthy lifestyle . A total of 303 patients completed the 1-year follow up . No change in systolic BP was noted in either the intervention group or the control group . Because of an increase in diastolic BP in the control group ( P = .03 ) , a difference in mean diastolic BP between the 2 groups was found at follow-up ( P = .007 ) . Mean BP at follow-up was 139/82 mm Hg in the intervention group and 142/86 mm Hg in the control group . Linear regression analysis demonstrated that BP at the point of discharge was the strongest predictor of BP 1 year later ( P < .0001 ) . The proportion of patients on antihypertensive medication increased in the intervention group ( P = .002 ) . Patients were compliant with antihypertensive therapy , and 92 % of the hypertensive patients in the intervention group followed the advice to see a general practitioner ( GP ) for BP checkups . At follow-up , 187 patients ( 62 % ) were hypertensive , with no difference in the rate of hypertension seen between the groups . Our data indicate that home visits by nurses did not result in a lowering of BP . Patients complied with antihypertensive therapy and GP visits in the case of hypertension . Nonetheless , the majority of patients were hypertensive at the 1-year follow up BACKGROUND Hypercholesterolemia control status is lacking throughout the western world . OBJECTIVES To examine whether the treatment recommendations given to ischemic heart disease patients at hospital discharge are compatible with the guidelines of the Israeli medical societies and the U.S. National Cholesterol Education Program for coronary artery disease prevention ; and to study the effects of brief educational sessions on the adherence of physicians with the guidelines . METHODS We included consecutive IHD patients admitted to four central hospitals in Israel between 1998 and 2000 . The study was conducted in two phases . In phase 1 , we review ed discharge letters to document treatment recommendations given to each patient . In phase 2 we educated the practitioners by review ing the Israeli medical societies and the NCEP guidelines and the quality of their recommendations in phase 1 , after which we reevaluated the discharge letters . RESULTS The study included 2,994 patients : 627 in phase 1 and 2,367 in phase 2 . Of the patients who needed cholesterol-lowering according to their low density lipoprotein levels  , 37.4 % were not prescribed such drugs at discharge ( under-treatment group ) . This proportion was reduced by education to 26.6 % ( P < 0.001 ) in phase 2 . Of the treated patients , 65.6 % did not reach the target LDL goal in phase 1 ( under-dosage group ) as compared to 60.2 % in phase 2 ( P = 0.23 ) . In phase 2 there was an increase in the percent of patients reaching LDL levels < 130 mg/day ( 69.3 % vs. 63.8 % of patients prescribed medication , P = 0.01 ) , but the percent of patients reaching ' LDL levels < 100 was not different in phase 2 after adjusting for age and gender ( the odds ratio for reaching target LDL was 1.16 , with 95 % confidence interval of 0.95 - 1.43 ) . CONCLUSIONS Physician recommendations to IHD patients discharged from hospital were suboptimal . We documented a high proportion of under-treated and under-dosaged patients . Brief educational sessions have a beneficial effect on the usage of statins ; however , additional effort in guideline implementations is needed STUDY OBJECTIVES To evaluate the outcome of a hospital discharge statin drug therapy initiation protocol  following coronary artery bypass graft ( CABG ) surgery . Our goal was to measure the percentage of patients receiving statin drugs at hospital discharge and at a post-hospital discharge assessment following the implementation of the statin drug therapy initiation protocol . We also evaluated low-density lipoprotein cholesterol ( LDL-C ) goal attainment ( ie , < 100 mg/dL ) , safety monitoring , and tolerability of the statin drug . DESIGN Single-center , observational study with a historical control group . SETTING University-affiliated health system with a comprehensive heart care program that included a 14-bed cardiac surgery ICU . Approximately 400 CABG procedures are performed annually . PATIENTS Patients who underwent CABG surgery were eligible for inclusion in the study . The exclusion criteria were as follows : contraindications to statin therapy ; refusal to take a statin drug ; refusal to give informed consent ; and age < 18 years . INTERVENTION A protocol was implemented to recommend treatment with a statin drug at hospital discharge in all post-CABG surgery patients if the presurgical LDL-C level was > 100 mg/dL or the patient was receiving a statin prior to hospital admission . The protocol also included a presurgical assessment of lipoprotein levels and hepatic function . All cardiac surgery staff were educated regarding the specifics of the protocol . RESULTS A total of 403 patients were included in the study . The historical  control  group ( 202 subjects ) and the intervention group ( 201 subjects ) were similar with respect to gender , age , and baseline lipoprotein levels . The follow-up assessment interval was approximately 6 months in both groups . Overall , patients were more likely to receive a statin at hospital discharge in the intervention group compared to the control group ( relative risk [ RR ] , 1.6 ; 95 % confidence interval [ CI ] , 1.3 to 2.0 ) . Attainment of the goal for LDL-C level was similar between the intervention and control groups in the overall sample . Patients who were not at their  LDL-C goal at baseline were more likely to have a follow-up LDL-C level of < 100 mg/dL in the intervention group ( RR , 1.9 ; 95 % CI , 1.0 to 3.5 ) . The rate of liver function assessment was similar in the control and intervention groups . No patients in either group experienced elevations of alanine aminotransferase levels that were more than three times the upper limit of normal , and no cases of muscle toxicity were noted . CONCLUSION The initiation of therapy with a statin drug at hospital discharge following CABG surgery was associated with increased utilization rates . The LDL-C goal attainment improved in patients who were not at their goal prior to surgery . However , the persistence of medication use declined within 6 months . Statin therapy initiation was well-tolerated in this cohort of patients BACKGROUND Adherence to medications that are prescribed after myocardial infa rct ion is poor . Eliminating out-of-pocket costs may increase adherence and improve outcomes . METHODS We enrolled patients discharged after myocardial infa rct ion and r and omly assigned their insurance-plan sponsors to full prescription coverage ( 1494 plan sponsors with 2845 patients ) or usual prescription coverage ( 1486 plan sponsors with 3010 patients ) for  all statins , beta-blockers , angiotensin-converting-enzyme inhibitors , or angiotensin-receptor blockers . The primary outcome was the first major vascular event or revascularization . Secondary outcomes were rates of medication adherence , total major vascular events or revascularization , the first major vascular event , and health expenditures . RESULTS Rates of adherence ranged from 35.9 to 49.0 % in the usual-coverage group and were 4 to 6 percentage points higher in the full-coverage group ( P<0.001 for all comparisons ) . There was no significant between-group difference in the primary outcome ( 17.6 per 100 person-years in the full-coverage group vs. 18.8 in the usual-coverage group ; hazard ratio , 0.93 ; 95 % confidence interval [ CI ] , 0.82 to 1.04 ; P=0.21 ) . The rates of total major vascular events or revascularization were significantly reduced in the full-coverage group ( 21.5 vs. 23.3 ; hazard ratio , 0.89 ; 95 % CI , 0.90 to 0.99 ; P=0.03 ) , as was the rate of the first major vascular event ( 11.0 vs. 12.8 ; hazard ratio , 0.86 ; 95 % CI , 0.74 to 0.99 ; P=0.03 ) . The elimination of copayments did not increase total spending ( $ 66,008 for the full-coverage group and $ 71,778 for the usual-coverage group ; relative spending , 0.89 ; 95 % CI , 0.50 to 1.56 ; P=0.68 ) . Patient costs were reduced for drugs and other services ( relative spending , 0.74 ; 95 % CI , 0.68 to 0.80 ; P<0.001 ) . CONCLUSIONS The elimination of copayments for drugs prescribed after myocardial infa rct ion did not significantly reduce rates of the trial 's primary outcome . Enhanced prescription coverage improved medication adherence and rates of first major vascular events and decreased patient spending without increasing overall health costs . ( Funded by Aetna and the Commonwealth Fund ; MI FREEE Clinical Trials.gov number , NCT00566774 . ) Summary Background : Statins are life saving drugs in cardiovascular practice . However , they still are underprescribed in many situations despite their well-established benefits . Adherence may be improved by increased comprehension of the patients . Methods : Patients enrolled into a previous survey were r and omized into two groups as those , who were informed comprehensively ( Group 1 ) and those not ( Group 2 ) . 202 patients , all of whom were on secondary prevention , were contacted after median 15 months of follow up and evaluated whether they continued the statins , and reached targets . Results : 102 out of 202 patients were those enrolled into Group 1 , and 100 of them were those enrolled into Group 2 . In Group 1 , 62.7 % of patients were on continuous statin therapy during period betweeen initial and secondary contact , whereas , only 46 % of patients in Group 2 were on continuous statin therapy ( p = 0.017 ) . Being well-informed about  statin  increased the likelihood of being on continuous statin therapy after median of 15 months by 1.977 folds . Concerning targets , 64.7 % of those in Group 1 reached the targets , whereas , 43 % of those in Group 2 reached the targets ( p = 0.002 ) . Being well-informed about statin  increased the likelihood of having suggested targets by ATP III after median of 15 months by 2.430 folds . Conclusion : Providing patients with comprehensive knowledge about statins , even in patients , who were already on statin therapy , seems not only to improve adherence but also increase the percentage of those reaching targets This r and omized , controlled trial evaluated the impact of personalized follow-up on compliance rates in high-risk patients receiving combination lipid-lowering therapy over 2 years . A r and om sample of 30 patients 7 - 30 days after cardiac surgery had baseline fasting low-density lipoprotein levels higher than 130 mg/dl . All patients received lovastatin 20 mg/day and colestipol 5 g twice/day . Weekly telephone contact was made with each patient for 12 weeks . Short- and long-term compliance was assessed by pill and packet counts and refill records . Compliance and lipid profile results were significantly better in the intervention group ( p<0.05 ) up to 2 years after the start of therapy than in the control group for all parameters except high-density lipoprotein . However , this effect was not apparent during the first 12 weeks of therapy . Short-term telephone follow-up favorably affected compliance and lipid profile results up to 2 years after start of therapy Proven strategies to reduce risk of stroke recurrence are under‐utilized . We sought to evaluate the impact of st and ardized stroke discharge orders on treatment practice s in a cluster‐r and omized trial
target: Full prescription coverage , reduced copayments , FDC and counselling were facilitators associated with higher adherence .
background: BACKGROUND Secondary prevention is cost-effective for cardiovascular disease ( CVD ) , but uptake is suboptimal .
  Underst and ing barriers and facilitators to adherence to secondary prevention for CVD at multiple health system levels may inform policy .
  OBJECTIVES To conduct a systematic review of barriers and facilitators to adherence/persistence to secondary CVD prevention medications at health system level .