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Efficacy of eHealth Technologies on Medication Adherence in Patients With Acute Coronary Syndrome: Systematic Review
Akshaya Srikanth Bhagavathula1, Wafa Ali Aldhaleei2, Tesfay Mehari Atey3
1Department of Public Health, College of Health and Human Services, North Dakota State University, Fargo, ND, United States.
Insights
eHealth interventions do not improve medication adherence in acute coronary syndrome (ACS) patients. This meta-analysis of randomized controlled trials found no significant benefit for adherence to cardiac medications like statins or aspirin.
Area of Science:
- Cardiology
- Digital Health
- Pharmacotherapy
Background:
- Suboptimal adherence to cardiac medications post-acute coronary syndrome (ACS) is linked to adverse outcomes.
- eHealth technologies show promise in reducing cardiovascular risk factors.
- Limited data exists on eHealth's impact on medication adherence in ACS patients.
Purpose of the Study:
- To evaluate the effectiveness of eHealth interventions on medication adherence in ACS patients.
- To assess adherence to five key cardioprotective medication classes.
Main Methods:
- Systematic literature search of major databases (PubMed, Embase, Scopus, Web of Science) updated to October 2023.
- Included randomized controlled trials (RCTs) assessing eHealth tools (texting, apps) for medication adherence post-ACS.
- Performed a meta-analysis using a fixed-effect model to analyze adherence to statins, aspirin, P2Y12 inhibitors, ACE inhibitors/ARBs, and beta-blockers.
Main Results:
- Analysis of 5 RCTs involving 4100 participants showed no significant improvement in adherence to any of the five medication classes with eHealth interventions.
- Adherence rates for statins, P2Y12 inhibitors, aspirin, ACE inhibitors/ARBs, and beta-blockers were not significantly different between eHealth and control groups at 6 and 12 months.
- No improvement in adherence was observed regardless of the assessment method (self-report or objective).
Conclusions:
- Current evidence suggests eHealth interventions have limited effectiveness in improving medication adherence post-ACS.
- Further research is needed to explore the role of various eHealth strategies in the post-ACS population.
- The findings highlight a gap in utilizing digital health for optimizing adherence to guideline-recommended therapies after ACS.
Background:
Suboptimal adherence to cardiac pharmacotherapy, recommended by the guidelines after acute coronary syndrome (ACS) has been recognized and is associated with adverse outcomes. Several randomized controlled trials (RCTs) have shown that eHealth technologies are useful in reducing cardiovascular risk factors. However, little is known about the effect of eHealth interventions on medication adherence in patients following ACS.
Objective:
The aim of this study is to examine the efficacy of the eHealth interventions on medication adherence to selected 5 cardioprotective medication classes in patients with ACS.
Methods:
A systematic literature search of PubMed, Embase, Scopus, and Web of Science was conducted between May and October 2022, with an update in October 2023 to identify RCTs that evaluated the effectiveness of eHealth technologies, including texting, smartphone apps, or web-based apps, to improve medication adherence in patients after ACS. The risk of bias was evaluated using the modified Cochrane risk-of-bias tool for RCTs. A pooled meta-analysis was performed using a fixed-effect Mantel-Haenszel model and assessed the medication adherence to the medications of statins, aspirin, P2Y12 inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and β-blockers.
Results:
We identified 5 RCTs, applicable to 4100 participants (2093 intervention vs 2007 control), for inclusion in the meta-analysis. In patients who recently had an ACS, compared to the control group, the use of eHealth intervention was not associated with improved adherence to statins at different time points (risk difference [RD] -0.01, 95% CI -0.03 to 0.03 at 6 months and RD -0.02, 95% CI -0.05 to 0.02 at 12 months), P2Y12 inhibitors (RD -0.01, 95% CI -0.04 to 0.02 and RD -0.01, 95% CI -0.03 to 0.02), aspirin (RD 0.00, 95% CI -0.06 to 0.07 and RD -0.00, 95% CI -0.07 to 0.06), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RD -0.01, 95% CI -0.04 to 0.02 and RD 0.01, 95% CI -0.04 to 0.05), and β-blockers (RD 0.00, 95% CI -0.03 to 0.03 and RD -0.01, 95% CI -0.05 to 0.03). The intervention was also not associated with improved adherence irrespective of the adherence assessment method used (self-report or objective).
Conclusions:
This review identified limited evidence on the effectiveness of eHealth interventions on adherence to guideline-recommended medications after ACS. While the pooled analyses suggested a lack of effectiveness of such interventions on adherence improvement, further studies are warranted to better understand the role of different eHealth approaches in the post-ACS context.
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