Interventions to improve medication adherence in coronary disease patients: A systematic review and meta-analysis of randomised controlled trials

Karla Santo; Suzanne Kirkendall; Tracey-Lea Laba; Jay Thakkar; Ruth Webster; John Chalmers; Clara K Chow; Julie Redfern

doi:10.1177/2047487316638501

Interventions to improve medication adherence in coronary disease patients: A systematic review and meta-analysis of randomised controlled trials

Eur J Prev Cardiol. 2016 Jul;23(10):1065-76. doi: 10.1177/2047487316638501. Epub 2016 Mar 14.

Authors

Karla Santo¹, Suzanne Kirkendall², Tracey-Lea Laba³, Jay Thakkar⁴, Ruth Webster³, John Chalmers³, Clara K Chow⁴, Julie Redfern³

Affiliations

¹ The George Institute for Global Health, University of Sydney, Australia Sydney Medical School, University of Sydney, Australia ksanto@georgeinstitute.org.au.
² Sydney Medical School, University of Sydney, Australia.
³ The George Institute for Global Health, University of Sydney, Australia Sydney Medical School, University of Sydney, Australia.
⁴ The George Institute for Global Health, University of Sydney, Australia Sydney Medical School, University of Sydney, Australia Cardiology Department, Westmead Hospital, Australia.

PMID: 26976848
DOI: 10.1177/2047487316638501

Abstract

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.

Keywords: Medication adherence; coronary disease; medication compliance; meta-analysis; multiple medications; polypharmacy; randomised controlled trial; systematic review.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Cardiovascular Agents / therapeutic use*
Coronary Disease / drug therapy*
Humans
Medication Adherence*
Randomized Controlled Trials as Topic*

Substances

Cardiovascular Agents