{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T23:45:49Z","timestamp":1790207149592,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,5,2]],"date-time":"2018-05-02T00:00:00Z","timestamp":1525219200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008349","name":"Boehringer Ingelheim","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008349","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004312","name":"Eli Lilly and Company","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004312","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009947","name":"Merck Sharp and Dohme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009947","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008976","name":"Sanofi-Aventis Korea Company","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008976","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Most patients are recommended secondary prevention pharmacotherapies following an acute coronary syndromes (ACS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To identify predictors of adherence at 6 months and strategies to improve adherence to these therapies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients in the CONCORDANCE registry who were discharged on evidence\u2010based medications were stratified into those receiving \u226575% (\u2018adherent\u2019) or &lt;75% (\u2018non\u2010adherent\u2019) of indicated medications at 6 months. Baseline characteristics, hospital and post\u2010discharge care were compared between groups. Multivariable logistic analysis identified independent predictors of adherence. The relative contribution of each clinical or treatment factor to \u2018adherence\u2019 was determined using an adequacy measure method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Follow\u2010up data were available for 6595 patients, 4492 (68.1%) of whom were \u2018adherent\u2019. Clinical factors predictive of adherence included previous stroke, percutaneous coronary intervention (PCI) and hypertension (odds ratios (OR) 1.36\u20131.56); factors predictive of non\u2010adherence included discharge diagnosis of non\u2013ST\u2010segment elevation myocardial infarction (vs unstable angina) (OR 0.51) and atrial fibrillation (OR 0.59). Discharge on \u226575% of indicated medications was a strong predictor of adherence at 6 months (OR 10.23, 95% confidence interval 7.89\u221213.27); in\u2010hospital management factors predicting non\u2010adherence were medical management alone (OR 0.34) and coronary artery bypass graft (OR 0.50) (both vs PCI). Post\u2010discharge predictors of adherence included cardiac rehabilitation (OR 1.36) and general practitioner attendance (OR 1.40).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Failure to discharge patients on indicated therapies is the most important modifiable predictor of adherence failure 6 months after an ACS. Implementing protocols to automate prescription of indicated discharge therapies, has the potential to reduce non\u2010adherence dramatically in the 6 months following discharge.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.13736","type":"journal-article","created":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T14:05:47Z","timestamp":1516284347000},"page":"541-549","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Improving patient adherence to secondary prevention medications 6 months after an acute coronary syndrome: observational cohort study"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6115-0326","authenticated-orcid":false,"given":"David","family":"Brieger","sequence":"first","affiliation":[{"name":"Department of Cardiology Concord Repatriation General Hospital and The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Westmead Hospital The University of Sydney  Sydney New South Wales Australia"},{"name":"Charles Perkins Centre The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice","family":"Gullick","sequence":"additional","affiliation":[{"name":"Sydney Nursing School The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karice","family":"Hyun","sequence":"additional","affiliation":[{"name":"Cardiovascular Division The George Institute for Global Health  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"D'Souza","sequence":"additional","affiliation":[{"name":"Clinical Research Centre Sydney Local Health District and The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Briffa","sequence":"additional","affiliation":[{"name":"School Population and Global Health The University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the CONCORDANCE Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,5,2]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Australian Institute of Health and Welfare. 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