TY - JOUR
T1 - Effectiveness of cardiac rehabilitation programs on medication adherence in patients with cardiovascular disease
T2 - A systematic review and meta-analysis
AU - On behalf of the NHMRC CHAP Project Team
AU - Gebremichael, Lemlem Gebremedhin
AU - Champion, Stephanie
AU - Nesbitt, Katie
AU - Pearson, Vincent
AU - Bulamu, Norma B.
AU - Dafny, Hila A.
AU - Sajeev, Shelda
AU - Pinero de Plaza, Maria Alejandra
AU - Ramos, Joyce S.
AU - Suebkinorn, Orathai
AU - Gulyani, Aarti
AU - Bulto, Lemma N.
AU - Beleigoli, Alline
AU - Hendriks, Jeroen M.
AU - Hines, Sonia
AU - Clark, Robyn A.
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2024/3
Y1 - 2024/3
N2 - Background: Education to improve medication adherence is one of the core components of cardiac rehabilitation (CR) programs. However, the evidence on the effectiveness of CR programs on medication adherence is conflicting. Therefore, we aimed to summarize the effectiveness of CR programs versus standard care on medication adherence in patients with cardiovascular disease. Methods: A systematic review and meta-analysis was conducted. Seven databases and clinical trial registries were searched for published and unpublished articles from database inception to 09 Feb 2022. Only randomised controlled trials and quasi-experimental studies were included. Two independent reviewers conducted the screening, extraction, and appraisal. The JBI methodology for effectiveness reviews and PRISMA 2020 guidelines were followed. A statistical meta-analysis of included studies was pooled using RevMan version 5.4.1. Results: In total 33 studies were included with 16,677 participants. CR programs increased medication adherence by 14 % (RR = 1.14; 95 % CI: 1.07 to 1.22; p = 0.0002) with low degree of evidence certainty. CR also lowered the risk of dying by 17 % (RR = 0.83; 95 % CI: 0.69 to 1.00; p = 0.05); primary care and emergency department visit by mean difference of 0.19 (SMD = −0.19; 95 % CI: −0.30 to −0.08; p = 0.0008); and improved quality of life by 0.93 (SMD = 0.93; 95 % CI: 0.38 to 1.49; p = 0.0010). But no significant difference was observed in lipid profiles, except with total cholesterol (SMD = −0.26; 95 % CI: −0.44 to −0.07; p = 0.006) and blood pressure levels. Conclusions: CR improves medication adherence with a low degree of evidence certainty and non-significant changes in lipid and blood pressure levels. This result requires further investigation.
AB - Background: Education to improve medication adherence is one of the core components of cardiac rehabilitation (CR) programs. However, the evidence on the effectiveness of CR programs on medication adherence is conflicting. Therefore, we aimed to summarize the effectiveness of CR programs versus standard care on medication adherence in patients with cardiovascular disease. Methods: A systematic review and meta-analysis was conducted. Seven databases and clinical trial registries were searched for published and unpublished articles from database inception to 09 Feb 2022. Only randomised controlled trials and quasi-experimental studies were included. Two independent reviewers conducted the screening, extraction, and appraisal. The JBI methodology for effectiveness reviews and PRISMA 2020 guidelines were followed. A statistical meta-analysis of included studies was pooled using RevMan version 5.4.1. Results: In total 33 studies were included with 16,677 participants. CR programs increased medication adherence by 14 % (RR = 1.14; 95 % CI: 1.07 to 1.22; p = 0.0002) with low degree of evidence certainty. CR also lowered the risk of dying by 17 % (RR = 0.83; 95 % CI: 0.69 to 1.00; p = 0.05); primary care and emergency department visit by mean difference of 0.19 (SMD = −0.19; 95 % CI: −0.30 to −0.08; p = 0.0008); and improved quality of life by 0.93 (SMD = 0.93; 95 % CI: 0.38 to 1.49; p = 0.0010). But no significant difference was observed in lipid profiles, except with total cholesterol (SMD = −0.26; 95 % CI: −0.44 to −0.07; p = 0.006) and blood pressure levels. Conclusions: CR improves medication adherence with a low degree of evidence certainty and non-significant changes in lipid and blood pressure levels. This result requires further investigation.
KW - Cardiac rehabilitation
KW - Clinical outcomes
KW - Effectiveness
KW - Medication adherence
KW - Standard care
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85181743472&partnerID=8YFLogxK
U2 - 10.1016/j.ijcrp.2023.200229
DO - 10.1016/j.ijcrp.2023.200229
M3 - Article
AN - SCOPUS:85181743472
SN - 2772-4875
VL - 20
JO - International Journal of Cardiology: Cardiovascular Risk and Prevention
JF - International Journal of Cardiology: Cardiovascular Risk and Prevention
M1 - 200229
ER -
