On average approximately half of patients do not adhere to

On average, approximately half of patients do not adhere to prescribed treatment regimens (Beardon et al., 1993). Studies have shown that poor adherence to beta-blockers or statin in post-MI patients can lead to an increased risk of morbidity and mortality (Kirking et al., 1995; Fincham and Wertheimer, 1988). After MI, several strategies including early follow up and sending printed reminders to patients were proposed to improve adherence (Jackevicius et al., 2002). Studies on non-adherence found that 1–21% of prescriptions were unfilled or not claimed from hospital pharmacies (Craghead and Wartski, 1991; Skutnik and Katsanis, 1997). In other studies, non-adherence to medications has been shown to increase mortality and hospitalizations (Jackevicius et al., 2007; Jackevicius et al., 2008).

Methods

Results
We did not experience any dropouts through the study. The demographic and anthropometric characteristics of the participants were shown in Table 1. The mean age was 53±2.1years. For the subjects with or without multiple cardiovascular risk factors adequate adherence was found to be 69.9% and 30.1%, respectively. The correlation between adherence and patient’s income was statistically significant among intermediate and high income patients. However, no such relation was documented in low income patients (Table 1).

Discussion
Cardiovascular diseases and hypertension are associated with enormous economic and personal burden through increased risk of stroke and kidney disease (Cherry et al., 2008; James et al., 2014; Go et al., 2013). The treatment of CVDs has been unequivocally shown to positively impact patient-related outcomes leading to reductions in stroke and heart failure (Chobanian et al., 2003).
In the current study, the predicting and estimated risk factors for non-adherence to prescribed cardiovascular medications were identified. Considering gender, our results indicated that males were less compliant with cardiovascular medications than females (Wang et al., 2005).Besides, education and high income also provide good adherence to drug regimens.
In patients who are treated with cardiovascular drug regimens, we have identified contributory factors to non-adherence as missed treatment doses or day(s), failure to report non-adherence, or interrupted treatment regimens. Besides, we have found 40% more adherence in patients over 65years as compared to those under 65years, which was in DNA Damage DNA Repair Library to the study by Monane et al., (1996).
Healthcare professionals have to shorten regimens where possible (Murphy et al., 2003; Black, 1999). Besides, they must educate their patients about the significance of adhering to their prescribed regimens. In accordance with currently available evidence, our findings highlighted that some patients lack medication knowledge and this is the major cause for poor adherence (Mini et al., 2012). In general, poly-pharmacy has major impact on adherence to cardiovascular medications (Stone et al., 2001; Golin et al., 2002) and the most frequent reason for non-adherence was multiple medications (poly-pharmacy) herein. Our current interventions succeeded in weaning patients’ negative beliefs, improving motivational barriers, indication of recall barrier and indication of access barrier to adherence and the improvement was sustained throughout the study period.
A retrospective study reported that compared to concurrent two-pill therapy single-pill combination therapy (contained in one pill dosage form) provided 20% higher adherence and more subjects from the single-pill combination therapy continued to take prescribed medication for 12months (Dezii, 2000; Haynes et al., 2008). In an electronic monitoring study conducted on 149 patients receiving cardiovascular medications, only dosing frequency (p=0.0001) but not drug class (P=0.71) was associated with medication adherence in the adjusted analysis. The authors have suggested that providers may consider using once daily formulations to optimize adherence and should assess adherence among all treated patients with uncontrolled hypertension (Moise et al., 2014). Thus, a plausible strategy to improve adherence to medications may include considering a combination single-pill therapy where applicable. In another study conducted by Castellano et al. (2014), the researchers suggested that use of a poly-pill strategy met the primary end point for adherence for secondary prevention following an acute MI (Castellano et al., 2014a). This was also evident for present study patients with poly-pharmacy and multiple adherence risk factors. Major trials are being conducted and they will hopefully provide definitive evidence on the efficacy of the poly-pill in reducing cardiovascular events in a cost-effective manner. The results of these trials will determine whether a poly-pill strategy can suppress the CVD pandemic and will potentially provide the evidence to implement in cost-effective, easy, simple, and innovative solution for the global burden of CVDs (Castellano et al., 2014).