IMPACT OF MEDICATION NONADHERENCE ON CORONARY HEART-DISEASE OUTCOMES - A CRITICAL-REVIEW

A critical review of published literature was performed to assess the impact of medication adherence on morbidity and mortality among patien ts with or at risk for coronary artery disease and congestive heart fa ilure. Twenty-one original research articles that met our inclusion cr iteria and related medication adherence to morbidity and mortality are summarized. No clinical trials that specifically tested the impact of a compliance-enhancing intervention on outcome in coronary heart dise ase were identified. Among 12 studies that compared hospitalization ra tes and mortality between adherers and nonadherers, 7 showed a signifi cant relationship between medication adherence and outcomes. Three stu dies showed that adherence to placebo was associated with improved out comes, suggesting that adherent behavior may be a marker of better pro gnosis or confers a protective effect on patients with coronary heart disease. Further study is necessary to determine whether adherent beha vior can be taught and whether compliance-enhancing strategies improve outcomes in coronary heart disease.