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Adherence to secondary prevention therapies in acute coronary syndrome

“Drugs don’t work in patients who don’t take them.” — C Everett Koop

Despite the overwhelming evidence of the effectiveness of secondary prevention therapies,1,2 surveys locally and overseas indicate poor uptake of medical treatments and lifestyle recommendations after an acute coronary syndrome (ACS),3,4 and a concerning lack of recognition of this problem by clinicians.35 In one cross-sectional survey of Australian general practices, only about a half of patients with known coronary heart disease were taking recommended treatments.5 This is similar to findings from other high-income countries, and the situation is much worse in low- and middle-income countries.6 Adherence to lifestyle recommendations is also poor, with only about a third of patients adherent to lifestyle recommendations on diet, exercise and smoking 6 months after their ACS.7

The World Health Organization defines adherence as “the extent to which a person’s behaviour — taking medication, following a diet, and/or executing lifestyle changes,…