Table 1

Summary of findings

Adherence intervention compared with usual care for secondary prevention of ASCVD
Patient or population: secondary prevention of ASCVD
Intervention: adherence intervention
Comparison: usual care
OutcomesEffect on outcomeNo. of participants (studies)Quality of the evidence (GRADE)Comments
ASCVD eventNo trials demonstrated an effect of the intervention on ASCVD events. The proportion of participants with an event in the intervention group ranged from 0.6% to 17.6% and in the control group from 0.6% to 18.8%.9501
(9 RCTs)
⨁◯◯◯
VERY LOW*†‡
Downgraded due to risk of bias, imprecision and inconsistency
Medication adherence12 of the 17 trials had a statistically significant effect on adherence. Three trials that showed no effect on adherence involved a transdisciplinary approach, pharmacist consultation service and discharge educational materials.17,448
(17 RCTs)
⨁⨁⨁◯
MODERATE*
Downgraded due to risk of bias
Change in systolic blood Change in systolic blood pressure
(continued)
The mean change ranged across intervention groups from −22.0 mm Hg to 0.3 mm Hg.6178
(9 RCTs)
⨁⨁◯◯
LOW*†
Downgraded due to risk of bias and inconsistency
The mean change in systolic blood pressure ranged across control groups from −13.2 mm Hg to 7.3 mm Hg.
Change in LDL-CThe mean change across intervention groups ranged from −13 mg/dL to 5.27 mg/dL2557
(5 RCTs)
⨁◯◯◯
VERY LOW*†‡
Downgraded due to high risk of bias, study inconsistency and imprecision
The mean change in LDL-C ranged across control groups from −12 mg/dL to 2.17 mg/dL.
  • *Downgraded due to risk of bias.

  • †Downgraded due to inconsistency.

  • ‡Downgraded due to imprecision.

  • §The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

  • GRADE Working Group grades of evidence (Guyatt et al 11).

  • High quality: We are very confident that the true effect lies close to that of the estimate of the effect.

  • Moderate quality: We are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

  • Low quality: Our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect.

  • Very low quality: We have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.

  • ASCVD, atherosclerotic cardiovascular disease; GRADE, Grading of Recommendations Assessment, Development and Evaluation; LDL-C, low-density lipoprotein cholesterol; RCT, randomised controlled trial; RR, risk ratio.