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Improving medication adherence in patients with cardiovascular disease: a systematic review
  1. Rosemary Hines Fuller1,2,
  2. Pablo Perel3,
  3. Tamara Navarro-Ruan4,
  4. Robby Nieuwlaat4,
  5. Robert Brian Haynes4,
  6. Mark D Huffman1,2
  1. 1 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2 Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3 Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  4. 4 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
  1. Correspondence to Dr Mark D Huffman, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; m-huffman{at}


Objective To evaluate and compare the effect of interventions for improving adherence to medications for atherosclerotic cardiovascular disease (ASCVD) secondary prevention.

Methods We extracted eligible trials from a 2014 Cochrane systematic review on adherence for any condition. We updated the search from CENTRAL, Medline, Embase, PsycINFO, CINAHL, Sociological Abstracts and trial registers through November 2016. Study reports needed to be from a randomised controlled trial, incorporate participants identified as having ASCVD and interventions aimed at improving adherence to medicines for secondary prevention of ASCVD and measure both adherence and a clinical outcome. Two reviewers independently determined the eligibility of studies, extracted data and conducted a narrative synthesis.

Results We identified 17 trials (n=17 448 participants). Most trials had high risk of bias in at least one domain. The intervention group adherence rates ranged from 44%to99% and the comparator group adherence rates ranged from 13% to 96%. Three distinct interventions reported improvements in both adherence and clinical outcomes: short message service (65% vs 13% of participants with high adherence in the intervention vs control group), a fixed-dose combination pill (86% vs 65% adherence, risk ratio of being adherent, 1.33; 95% CI 1.26 to 1.41) and a community health worker-based intervention (97% in the intervention group compared with 92% in the control group; OR=2.62, 95% CI 1.32 to 5.19).

Conclusions We identified three interventions that demonstrated improvements in adherence and clinical outcomes. Ongoing, longer-term trials will help determine whether short-term changes in adherence can be maintained and lead to differences in clinical events.

  • medication adherence
  • coronary artery disease
  • systemic review

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  • Contributors All authors designed the review. RHF, MDH and PP screened and extracted data. TN-R adjudicated data. RHF analysed data and wrote the first draft of the manuscript. All authors contributed important intellectual content to the drafted manuscript and approved it for publication.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MDH receives grant support from the World Heart Federation to serve as its senior program advisor for the Emerging Leaders program, which is sponsored by Boehringer Ingelheim and Novartis with prior support from BUPA and AstraZeneca. MDH has received grant support from the Cochrane Collaboration to complete a systematic review update on fixed-dose combination, or polypills, and travel support from the World Heart Federation to attend a meeting on polypills. PP led several studies on improving adherence for cardiovascular prevention for which his institution has received grants. He is Senior Science Advisor at the World Heart Federation, which is supported, among other funders, by pharmaceutical companies.

  • Patient consent None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no unpublished data from the study.