Patient adherence after coronary bypass grafting: different facets of same matter. A systematic review

Background. Adherence in cardiological patients is a leading challenge due to a high society burden imposed by cardiovascular diseases (CVDs) through morbidity, reduced life expectancy, disability and high mortality rates in population. Despite the availability of highly effective medicines and high-technology care, the success of CVD treatment remains insufficient. A particular focus should be placed on patients with previous coronary artery bypass grafting (CABG). Objectives. A review of reasoning for non-adherence to medication and non-medication management in post-CABG patients and current methods influencing it. Methods. Russian-language and foreign literature was mined in the eLibrary and PubMed databases with the query keywords “medication adherence” [приверженность терапии], “coronary artery disease” [ишемическая болезнь сердца], “coronary artery bypass surgery” [коронарное шунтирование], “coronary revascularisation” [вторичная профилактика после коронарного шунтирования]. The review included papers published within 2016–2020, as well as selected relevant publications from 2003–2015, to cover 52 sources irrespective of study design and language. Content and descriptive analyses were used as research tools. Results. Coronary heart disease (CHD) poses an important health, social and economic problem worldwide as a leading cause of reduced life expectancy, disability and high mortality. Non-compliance with medication significantly bursts medical expenditures [1]. Coronary artery bypass grafting is used widely to treat multivessel coronary lesions both in stable and acute CHD. Secondary preventive techniques successfully preclude adverse post-CABG events, but adherence to post-CABG treatment is often low. The non-adherence rationale rarely links to a single factor but is rather complex and multifaceted. It includes social and economic reasons, systemic health care or personnel, therapy and patient-related factors. Methods are developing and refining to improve adherence to both non-medication and medication interventions. Conclusion. Clinical trials to improve secondary prevention adherence in patients after coronary artery bypass grafting will allow a wider implementation of relevant methods in outpatient management of this patient category.