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

What is it about?

Adherence to a combination of long-term cardiovascular medications is a cornerstone of coronary heart disease management and prevention. However, adherence to these medications is sub-optimal worldwide. Poor adherence to long-term medication, including cardiovascular medications, is a global concern highlighted by the World Health Organisation report in 2003 and is associated with increased morbidity, mortality and costs. Therefore, it is important to determine whether interventions improve adherence to guideline-recommended cardiovascular medications and which interventions are more likely to be associated with improved adherence. In this manuscript published in the European Journal of Preventive Cardiology, the world’s leading journal in preventive cardiology, we aimed to answer these research questions.

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Why is it important?

This work is the first review to have a focus on a population with coronary heart disease and on interventions that aimed to improve adherence to multiple cardiovascular medications, as patients with coronary heart disease are required to take not only one medication but a combination of long-term cardiovascular medications after a cardiac event. In addition, this review extends the knowledge in medication adherence research as it is the first one to conduct a meta-analysis of the effects of the interventions and provide a quantitative measure of the effects of interventions on adherence. Our results show that interventions aimed at improving adherence to multiple cardiovascular medications significantly improved the odds of being adherent and that interventions classified as simple were found to have similar results when compared to more complex interventions. This knowledge is important so that healthcare professionals and policy makers have an understanding that implementing interventions with a focus on medication adherence can provide benefits to the patients and more broadly to the healthcare system, as healthcare costs can be reduced if patients adhere to their medications and consequently have a reduction in cardiac events. This understanding may impact future research to determine which types of interventions are more effective and cost-effective; as highlighted in our paper we suggest that simple one-component interventions might be a promising way of improving adherence as they would be easier to replicate in different settings and on a large scale, however this needs to be further evaluated by future research. Furthermore, this knowledge can change both daily clinical practice, if healthcare professionals start to prioritize some time in consultations with their patients to focus on reinforcing adherence to medication, as well as healthcare systems, if healthcare authorities and policy makers decide to invest in medication adherence programs.