Barriers and facilitators to managing medicines at home post-myocardial infarction: a qualitative systematic review

Over three million people annually experience myocardial infarction (MI). As MI survival rates increase, so does the importance of secondary prevention medications. International guidelines recommend using several medications to prevent further morbidity.

To synthesise the qualitative literature on the facilitators and barriers faced by MI survivors and their families/caregivers regarding medication management and, thus, medication adherence post-discharge.

This systematic review was conducted and reported following the PRISMA-2020 guidelines. Five databases were searched from inception until the 13th of August 2024. The inclusion criteria were articles focused on people aged 18 years or older who experienced MI and were discharged from acute care settings to home settings, as well as caregivers of individuals who met the above-mentioned criteria. Qualitative and mixed-methods studies with qualitative elements were deemed eligible for inclusion. The theoretical domain framework was used to analyse the findings. The quality of the included studies was assessed using the JBI Critical Appraisal tool for qualitative research. The Confidence in the Evidence from the reviews of qualitative research approach was applied to assess confidence in qualitative evidence synthesis.

Of the 14,002 titles, 11,354 remained after duplicates were removed. Of the 234 full-text screenings, fifteen were included. A total of 533 people who experienced MI and 25 spouses from eight different countries were included. The most prominent facilitator that emerged was "beliefs about consequences", whilst "lack of knowledge" and "environmental context and resources" were the most prominent barriers to medication management reported.

Patients face multiple challenges that affect their medication adherence post-MI. These findings highlight important considerations for creating an individualised, tailored approach to enhance medication adherence post-MI.

PROSPERO CRD42023424844.