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Interventions to improve medication adherence in coronary disease patients: A systematic review and meta-analysis of
Karla Santo1, Suzanne Kirkendall2, Tracey-Lea Laba3
1The George Institute for Global Health, University of Sydney, Australia Sydney Medical School, University of Sydney, Australia ksanto@georgeinstitute.org.au.
Insights
Interventions significantly improve medication adherence in coronary heart disease (CHD) patients. Simple, one-component strategies show promise for widespread adoption and improved cardiovascular health outcomes.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Sub-optimal adherence to multiple cardiovascular (CV) medications is a global challenge in coronary heart disease (CHD) management.
- Effective strategies are crucial for improving patient outcomes and reducing healthcare burdens.
Purpose of the Study:
- To systematically review and meta-analyze interventions aimed at enhancing adherence to multiple CV medications in patients with CHD.
- To assess the effectiveness of different intervention types on medication adherence.
Main Methods:
- A systematic review and meta-analysis were conducted following PRISMA guidelines.
- Randomized controlled trials evaluating interventions for CV medication adherence in CHD populations were identified and analyzed.
- Interventions were categorized as simple or complex, and adherence measures were pooled using odds ratios (ORs).
Main Results:
- Sixteen studies involving 10,706 patients demonstrated that interventions significantly improved medication adherence (OR 1.52; 95% CI 1.25-1.86).
- No significant differences in effectiveness were observed between complex and simple interventions.
- After adjusting for publication bias, the effect remained significant (OR 1.35; 95% CI 1.09-1.68).
Conclusions:
- Interventions to improve adherence to multiple CV medications in CHD patients significantly increase the likelihood of adherence.
- Simple, one-component interventions represent a promising, scalable approach for enhancing medication adherence in this population.
Background:
Adherence to multiple cardiovascular (CV) medications is a cornerstone of coronary heart disease (CHD) management and prevention, but it is sub-optimal worldwide. This review aimed to examine whether interventions improve adherence to multiple CV medications in a CHD population.
Design:
This study was based on a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
Methods:
Randomised controlled trials were identified by searching multiple databases and reference lists. Studies were selected if they evaluated interventions aiming to improve adherence to multiple CV medications targeting a CHD population and if they provided an appropriate measure of adherence. Interventions were classified as complex or simple interventions. Odds ratios (ORs) were calculated and pooled for a meta-analysis. Risk of bias, heterogeneity and publication bias were also assessed.
Results:
Sixteen studies (10,706 patients) were included. The mean age was 62 years (standard deviation (SD) 3.6) and 72% were male. In a pooled analysis, the interventions significantly improved medication adherence (OR 1.52; 95% confidence interval (CI) 1.25-1.86; p < 0.001) and there were no significant differences based on intervention type (complex vs simple), components categories and adherence method. There was moderate heterogeneity (I(2) ( )= 61%) across the studies. After adjusting for publication bias, the effect size was attenuated but remained significant (OR 1.35; 95% CI 1.09-1.68).
Conclusion:
Interventions to improve adherence to multiple CV medication in a CHD population significantly improved the odds of being adherent. Simple one-component interventions might be a promising way to improve medication adherence in a CHD population, as they would be easier to replicate in different settings and on a large scale.
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