Full prescription coverage , reduced copayments , FDC and counselling were facilitators associated with higher adherence .
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 .
Statin initiation following coronary artery bypass grafting: outcome of a hospital discharge protocol.
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
Full prescription coverage , reduced copayments , FDC and counselling were facilitators associated with higher adherence .
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 .