RT Journal Article SR Electronic T1 Improving medication adherence in patients with cardiovascular disease: a systematic review JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 1238 OP 1243 DO 10.1136/heartjnl-2017-312571 VO 104 IS 15 A1 Rosemary Hines Fuller A1 Pablo Perel A1 Tamara Navarro-Ruan A1 Robby Nieuwlaat A1 Robert Brian Haynes A1 Mark D Huffman YR 2018 UL http://heart.bmj.com/content/104/15/1238.abstract AB 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.