Can We Improve Adherence to Preventive Therapies for Cardiovascular Health?

Abstract

A lthough mortality rates from cardiovascular disease (CVD) declined by 26% from 1995 to 2005, 1 it remains the leading cause of death for US adults. The American Heart Association (AHA) set a 2020 impact goal to "improve the cardiovascular health of all Americans by 20% while reducing deaths from CVD and stroke by 20%." 2 To this end, the AHA recommended prevention as a first-line strategy and identified "life's simple seven," 3 lifestyle behaviors and risk factors described in Table 1, which, if appropriately followed or adhered to, will improve cardiovascular health. 2 Adherence refers to the extent to which patient behaviors align with clinical recommendations. 4 The prevention behaviors offered by the AHA can be categorized as follows: (1) lifestyle behaviors, (2) screening, and (3) medication use. Lifestyle behaviors include a healthy diet, maintaining a healthy weight, engaging in physical activity, and not smoking. Screenings include those for blood pressure, lipid levels, and diabetes mellitus. Medication use refers to over-thecounter medications such as aspirin and prescription medications such as lipid-lowering agents and antihypertensive medications.Adherence to preventive therapies is suboptimal. For example, only 5% of adults engage in the recommended amount of physical activity. 5 In comparison, about 43% of adults with a history of CVD or equivalent CVD risk take statins 6 and 57% of adults 25 years old had their cholesterol tested at least once in the past 5 years. 7 High-risk lifestyle behaviors are most prevalent in populations with limited income and education, ethnic/racial minority populations, and in low-income communities. 8,9 The challenge is even more complicated because having multiple risk factors is common. 10 A 2001 National Health Interview Survey reported a clustering of smoking, obesity, physical inactivity, and excessive alcohol intake (41% of US adults had 2 and 17% had 3). 8 Increased adherence to preventive therapies would greatly improve cardiovascular health, leading to reduced health disparities and healthcare costs. 11 Adherence to Preventive Therapies for Cardiovascular Health Is a Complex Process Influenced by Multiple FactorsTo improve adherence to preventive therapies, we must first understand the multiple levels that influence adherence. Within the healthcare system, adherence to preventive therapies is affected by patients, clinicians, and systems. 12 The Expanded Chronic Care Model (ECCM), an adaptation of the original CCM, provides a helpful framework for understanding how to integrate healthcare system-based approaches with communitybased health promotion efforts. 13 The CCM contains 4 components: (1) self-management, (2) delivery system design, (3) decision support, and (4) information systems. The ECCM added 3 components relevant to the community: (1) building public health policy, (2) creating supportive environments, and (3) strengthening community action (Figure 1). We review each of the components of the ECCM and provide examples of how they can be implemen...

Global Variation in the Prevalence of Elevated Cholesterol in Outpatients With Established Vascular Disease or 3 Cardiovascular Risk Factors According to National Indices of Economic Development and Health System Performance

“…1 In recognition of the extent to which patients, physicians, and healthcare systems all influence adherence to preventive therapies, a framework for the integration of healthcare system-based approaches with community-based health promotion efforts within the United States has also been proposed. 37 In addition, as part of the Million Hearts initiative, the US Centers for Medicare and Medicaid Services has expanded coverage for CVD prevention. 38 Efforts such as these, in combination with ensuring adequate infrastructure for surveillance of risk factors and health outcomes, are crucial for controlling the rising, yet preventable, burden of cardiovascular diseases and may serve as a template for other countries to build upon.…”

Lifestyle interventions based on the diabetes prevention program delivered via eHealth: A systematic review and meta-analysis

“…YMCA) (Ackermann et al, 2008). Modification for delivery via different electronic health approaches (eHealth) is also advocated (Atienza and Patrick, 2011; Green et al, 2012; Ockene et al, 2011; Wolfenden et al, 2010). The efficacy of DPP-based lifestyle interventions modified to the local context or modified for delivery via eHealth has been evaluated in several systematic reviews with and without meta-analysis (Ali et al, 2012; Whittemore, 2011).…”

Distância do domicílio ao local de exercício físico não influenciou a aderência de 796 participantes

“…Participants must determine when and where to perform the activity and use their self-motivation 27 . On the other hand, it seems clear that there is much to be done in relation to adherence to preventive therapies, which are known to be quite low, reporting that only 5% of adults engage in physical exercise in the recommended amount for the purposes of benefiting their health 33 .…”