{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:06:03Z","timestamp":1791597963631,"version":"4.3.4"},"reference-count":39,"publisher":"BMJ","issue":"2","funder":[{"name":"The Leeds Teaching Hospitals Charitable Foundation","award":["Grant"],"award-info":[{"award-number":["Grant"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2019,6,13]]},"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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 \u22653 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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 <jats:italic>number of individual daily doses<\/jats:italic> 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 <jats:italic>specific concern<\/jats:italic> 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2018-000997","type":"journal-article","created":{"date-parts":[[2019,7,4]],"date-time":"2019-07-04T10:57:01Z","timestamp":1562237821000},"page":"e000997","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":45,"title":["Adherence to coronary artery disease secondary prevention medicines: exploring modifiable barriers"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9707-234X","authenticated-orcid":false,"given":"Rani","family":"Khatib","sequence":"first","affiliation":[{"name":"Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, Leeds, UK"},{"name":"Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK"},{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay","family":"Marshall","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Silcock","sequence":"additional","affiliation":[{"name":"Bradford School of Pharmacy, University of Bradford, Bradford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Forrest","sequence":"additional","affiliation":[{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alistair S","family":"Hall","sequence":"additional","affiliation":[{"name":"Cardiology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK"},{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,7,3]]},"reference":[{"key":"2025081710054543000_6.2.e000997.1","unstructured":"National Institute for Health and Care Excellence . 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