Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta‐Analysis of Controlled Trials
BackgroundPoor adherence to medications is a common problem among heart failure (HF) patients. Inadequate adherence leads to increased HF exacerbations, reduced physical function, and higher risk for hospital admission and death. Many interventions have been tested to improve adherence to HF medicat...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2016-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.115.002606 |
| _version_ | 1818328036033953792 |
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| author | Todd M. Ruppar Pamela S. Cooper David R. Mehr Janet M. Delgado Jacqueline M. Dunbar‐Jacob |
| author_facet | Todd M. Ruppar Pamela S. Cooper David R. Mehr Janet M. Delgado Jacqueline M. Dunbar‐Jacob |
| author_sort | Todd M. Ruppar |
| collection | DOAJ |
| description | BackgroundPoor adherence to medications is a common problem among heart failure (HF) patients. Inadequate adherence leads to increased HF exacerbations, reduced physical function, and higher risk for hospital admission and death. Many interventions have been tested to improve adherence to HF medications, but the overall impact of such interventions on readmissions and mortality is unknown. Methods and ResultsWe conducted a comprehensive search and systematic review of intervention studies testing interventions to improve adherence to HF medications. Mortality and readmission outcome effect sizes (ESs) were calculated from the reported data. ESs were combined using random‐effects model meta‐analysis methods, because differences in true between‐study effects were expected from variation in study populations and interventions. ES differences attributed to study design, sample, and intervention characteristics were assessed using moderator analyses when sufficient data were available. We assessed publication bias using funnel plots. Comprehensive searches yielded 6665 individual citations, which ultimately yielded 57 eligible studies. Overall, medication adherence interventions were found to significantly reduce mortality risk among HF patients (relative risk, 0.89; 95% CI, 0.81, 0.99), and decrease the odds for hospital readmission (odds ratio, 0.79; 95% CI, 0.71, 0.89). Heterogeneity was low. Moderator analyses did not detect differences in ES from common sources of potential study bias. ConclusionsInterventions to improve medication adherence among HF patients have significant effects on reducing readmissions and decreasing mortality. Medication adherence should be addressed in regular follow‐up visits with HF patients, and interventions to improve adherence should be a key part of HF self‐care programs. |
| first_indexed | 2024-12-13T12:25:46Z |
| format | Article |
| id | doaj.art-6ce3483398df42cab212ffb33f6dd178 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T12:25:46Z |
| publishDate | 2016-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-6ce3483398df42cab212ffb33f6dd1782022-12-21T23:46:19ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-06-015610.1161/JAHA.115.002606Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta‐Analysis of Controlled TrialsTodd M. Ruppar0Pamela S. Cooper1David R. Mehr2Janet M. Delgado3Jacqueline M. Dunbar‐Jacob4Sinclair School of Nursing, University of Missouri, Columbia, MOSinclair School of Nursing, University of Missouri, Columbia, MODepartment of Family and Community Medicine, University of Missouri, Columbia, MOSinclair School of Nursing, University of Missouri, Columbia, MOSchool of Nursing, University of Pittsburgh, PABackgroundPoor adherence to medications is a common problem among heart failure (HF) patients. Inadequate adherence leads to increased HF exacerbations, reduced physical function, and higher risk for hospital admission and death. Many interventions have been tested to improve adherence to HF medications, but the overall impact of such interventions on readmissions and mortality is unknown. Methods and ResultsWe conducted a comprehensive search and systematic review of intervention studies testing interventions to improve adherence to HF medications. Mortality and readmission outcome effect sizes (ESs) were calculated from the reported data. ESs were combined using random‐effects model meta‐analysis methods, because differences in true between‐study effects were expected from variation in study populations and interventions. ES differences attributed to study design, sample, and intervention characteristics were assessed using moderator analyses when sufficient data were available. We assessed publication bias using funnel plots. Comprehensive searches yielded 6665 individual citations, which ultimately yielded 57 eligible studies. Overall, medication adherence interventions were found to significantly reduce mortality risk among HF patients (relative risk, 0.89; 95% CI, 0.81, 0.99), and decrease the odds for hospital readmission (odds ratio, 0.79; 95% CI, 0.71, 0.89). Heterogeneity was low. Moderator analyses did not detect differences in ES from common sources of potential study bias. ConclusionsInterventions to improve medication adherence among HF patients have significant effects on reducing readmissions and decreasing mortality. Medication adherence should be addressed in regular follow‐up visits with HF patients, and interventions to improve adherence should be a key part of HF self‐care programs.https://www.ahajournals.org/doi/10.1161/JAHA.115.002606heart failurehospitalizationinterventionmedication adherencemeta‐analysismortality |
| spellingShingle | Todd M. Ruppar Pamela S. Cooper David R. Mehr Janet M. Delgado Jacqueline M. Dunbar‐Jacob Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta‐Analysis of Controlled Trials Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease heart failure hospitalization intervention medication adherence meta‐analysis mortality |
| title | Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta‐Analysis of Controlled Trials |
| title_full | Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta‐Analysis of Controlled Trials |
| title_fullStr | Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta‐Analysis of Controlled Trials |
| title_full_unstemmed | Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta‐Analysis of Controlled Trials |
| title_short | Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta‐Analysis of Controlled Trials |
| title_sort | medication adherence interventions improve heart failure mortality and readmission rates systematic review and meta analysis of controlled trials |
| topic | heart failure hospitalization intervention medication adherence meta‐analysis mortality |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.115.002606 |
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