Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: A systematic review

Abstract

Background: Secondary prevention is cost-effective for cardiovascular disease (CVD), but uptake is suboptimal. Understanding 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.Methods: Included studies reported effects of health system level factors on adherence/persistence to secondary prevention medications for CVD (coronary artery or cerebrovascular disease). Studies considered at least one of β blockers, statins, angiotensin-renin system blockers and aspirin. Relevant databases were searched from 1 January 1966 until 1 October 2015. Full texts were screened for inclusion by 2 independent reviewers.