Open AccessMedication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta‐Analysis of Controlled Trials
Author(s) -
Ruppar Todd M.,
Cooper Pamela S.,
Mehr David R.,
Delgado Janet M.,
DunbarJacob Jacqueline M.
Publication year - 2016
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.115.002606
Subject(s) - medicine , psychological intervention , meta analysis , odds ratio , moderation , randomized controlled trial , funnel plot , odds , heart failure , relative risk , emergency medicine , medline , publication bias , confidence interval , intensive care medicine , logistic regression , psychiatry , psychology , social psychology , political science , law
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 ( ES s) were calculated from the reported data. ES s 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.