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Measuring patient adherence in secondary prevention of atherosclerotic cardiovascular disease: a scoping review
Malene Glud1,2, Nikolaj Thure Krarup3, Carsten B Juhl4,5
1Vascular Research Unit, Department of Vascular Surgery, Hospitalsenhed Midt, Viborg, Denmark.
Insights
This review found medication adherence is most studied in atherosclerotic cardiovascular disease (ASCVD) prevention. However, inconsistent measurement methods, often using unspecified patient-reported outcomes, hinder quality evaluation.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Preventive Cardiology
Background:
- Atherosclerotic cardiovascular disease (ASCVD) is a leading global cause of mortality.
- ASCVD is largely preventable through adherence to treatment strategies.
- Identifying and mapping adherence measurements is crucial for improving secondary prevention.
Purpose of the Study:
- To identify, categorize, and map adherence measurements for preventive treatment strategies in ASCVD patients.
- To provide an overview of commonly used adherence measurements across different ASCVD categories.
Main Methods:
- A scoping review was conducted following Joanna Briggs Institute (JBI) methodology.
- Searches were performed across major databases (PubMed, CINAHL, Web of Science, EMBASE) in May 2023, updated November 2024.
- Included observational studies of adults (≥18 years) with ASCVD and reported adherence measures, with data synthesized from 108 studies.
Main Results:
- Medication adherence was the most frequently assessed domain (67% of studies), followed by smoking cessation (65%) and guideline adherence for low-density lipoprotein cholesterol (36%).
- Unspecified patient-reported outcome measures (PROMs) were the most common method for assessing medication adherence (22% of studies).
- Male predominance (85%) and age range (40-91 years) were noted in the included ASCVD populations.
Conclusions:
- Medication adherence is the most assessed area in ASCVD secondary prevention, with unspecified PROMs being the predominant measurement tool.
- The lack of a standardized, gold-standard adherence measure across ASCVD studies presents a significant challenge for evaluating treatment effectiveness.
- Further research is needed to establish consistent and validated adherence measurement approaches in ASCVD management.
Objective:
Atherosclerotic cardiovascular disease (ASCVD) is the main cause of death globally, but is by and large a preventable disease. We wished to identify, categorise and map adherence measurements of preventative treatment strategies in patients with ASCVD.
Design And Data Sources:
We conducted a scoping review according to the Joanna Briggs Institue (JBI) methodology and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search was performed in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and EMBASE (Elsevier Biomedical Research database). The search was conducted in May 2023 and updated in November 2024.
Eligibility Criteria:
Observational studies pertaining to major types of ASCVD and related preventive treatment with reported adherence measures in adults over the age of 18 were included in this review.
Data Extraction And Synthesis:
Title and abstract and subsequent full-text review were performed by two independent reviewers in duplicate. We presented data from the included 108 studies and synthesised the results in an overview of the most commonly used adherence measurements according to ASCVD category.
Results:
A total of 108 records met the inclusion criteria. ASCVD populations included ranged in age from 40 to 91 years, with a male predominance (85%). Medication adherence was mostly reported by the proportion of patients taking their medication (15 studies, 14%) or the proportion of days covered (12 studies, 11%). Among the 108 included studies, 67 (62%) reported on medication adherence, 65 (60%) on smoking cessation, 39 (36%) on low-density lipoprotein cholesterol guideline adherence, 39 (36%) on exercise, 17 (16%) on diet and 11 (10%) on alcohol abstinence. Unspecified patient-reported outcome measures (PROMs) were the most used method for assessing medication adherence, reported in 15 studies (22%).
Conclusion:
Medication adherence was the most frequently assessed domain in secondary prevention of ASCVD, with unspecified PROMs being the most applied measurement approach. Lack of a gold standard combined with inconsistent adherence measures across studies of ASCVD continues to pose a significant challenge for evaluating treatment quality.
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