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Review
. 2016 Jun 17;5(6):e002606.
doi: 10.1161/JAHA.115.002606.

Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta-Analysis of Controlled Trials

Todd M Ruppar  1 , Pamela S Cooper  2 , David R Mehr  3 , Janet M Delgado  2 , Jacqueline M Dunbar-Jacob  4
Affiliations
Review

Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta-Analysis of Controlled Trials

Todd M Ruppar et al. J Am Heart Assoc. .

Abstract

Background: Poor 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 results: We 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.

Conclusions: Interventions 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.

Keywords: heart failure; hospitalization; intervention; medication adherence; meta‐analysis; mortality; readmission; systematic review.

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Figures

Figure 1
Figure 1
Funnel plot for mortality outcomes.
Figure 2
Figure 2
Funnel plot for readmission outcomes.
Figure 3
Figure 3
Flow diagram of study selection. s=number of studies. HF indicates heart failure; MA, medication adherence.
Figure 4
Figure 4
Forest plot for mortality outcome. RR indicates relative risk.
Figure 5
Figure 5
Forest plot for readmissions outcome. OR indicates odds ratio.
See this image and copyright information in PMC

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