UCL Institute of Health Informatics


The prescription persistence cascade in cardiovascular disease

The Problem

Drugs represent 10% of total UK health expenditure and for cardiovascular disease, which is the major cause of burden of disease in the UK, 18% of spending is on drugs. Despite polypharmacy (multiple drugs) and multi-morbidity (multiple diseases), there is poor adherence (whether drugs are taken as prescribed) and persistence (whether drugs continue to be taken over time) for drugs across cardiovascular diseases and this is associated with poor outcomes. There is limited understanding of the factors causing poor adherence and the impact across drugs and diseases, and interventions to improve adherence and persistence have proved to be elusive.

Our Research

A cascade of missed opportunities exists from guideline recommendation of a drug and prescription by the health professional, through adherence and persistence by the patient, to the “real-world” impact of the drug at population level.  Big data science allows the steps in the cascade to be studied together across drugs and diseases in ways which were previously not possible.  We will be using electronic health records and data from the Global Burden of Disease Study to model prescription, adherence and persistence, as well as the population impact of drugs in individuals with coronary artery disease, heart failure and atrial fibrillation. Our research will span several disciplines, including informatics, epidemiology, computer science and pharmacy. The aim is to develop tools for measurement, prediction and improvement of drug adherence in routine clinical practice. A new branches of science such as genomics consider the biology of drug effects, our research will provide a framework to consider the prescription-persistence cascade.  


Learning health systems

Precision medicine

Public health




Professor Harry Hemingway

Dr Amitava Banerjee

Professor Aroon Hingorani


Professor Rob Horne

Professor Anthony Hunter

Dr John Robson


Chung SC, Sundström J, Gale CP, James S, Deanfield J, Wallentin L, Timmis A, Jernberg T, Hemingway H; Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies/Register of Information and Knowledge about Swedish Heart Intensive care Admissions; National Institute for Cardiovascular Outcomes Research/Myocardial Ischaemia National Audit Project; CAardiovascular Disease Research Using Linked Bespoke Studies and Electronic Health Records. Comparison of hospital variation in acute myocardial infarction care and outcome between Sweden and United Kingdom: population based cohort study using nationwide clinical registries. BMJ 2015; Aug 7;351:h3913.

Horne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients' adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework. PLoS One 2013;8(12):e80633.

Banerjee A, Lane DA, Torp-Pedersen C, Lip GY. Net clinical benefit of new oral anticoagulants (dabigatran, rivaroxaban, apixaban) versus no treatment in a 'real world' atrial fibrillation population: a modelling analysis based on a nationwide cohort study. Thromb Haemost 2012;107(3):584-9.

Banerjee A, Hollis A, Pogge T. The Health Impact Fund: incentives for improving access to medicines. Lancet 2010;375(9709):166-9.