Compelling evidence supports cardiovascular medications in the secondary prevention of coronary artery disease, but many patients discontinue treatment. Mohammed Rashid and colleagues at the Primary Care Unit explore influences on patient decisions about medication, showing how clinicians can make an important difference .
A systematic review of 17 studies involving 391 patients teases out the extent to which clinicians, patient self-perceptions and disease understanding influence patients’ decisions to either continue or stop taking their medications.
Analyses suggest that some patients hold fatalistic beliefs about their disease, whereas others feel they have been cured by interventional procedures, both leading to a failure to take medication.
In contrast, the researchers found that patients who adapt to being a “heart patient” are positive about medication taking. Notably, they found that relationships with prescribing clinicians are of critical importance to patients, with inaccessibility and insensitive terminology negatively affecting patients’ perceptions about treatments.
By adopting a more open approach, clinicians can engage patients in a discourse about what they think about their medications. Moreover, they assert that providing medication-specific information when initiating therapy, improving the transition between secondary and primary care, and explaining the risk of disease recurrence may all help to modify patient attitudes toward drugs to prevent further cardiovascular disease.
The authors conclude that strategies to promote higher persistence of secondary prevention medications in patients with coronary artery disease need to recognize the key role of the prescribing clinician.