Interventions to improve medication adherence in heart failure: A systematic review

Objectives: There is clear evidence that pharmacotherapy improves survival and reduces hospitalisation due to heart failure; however, medication adherence is sub-optimal. The purpose of this review was to establish which interventions are effective in enhancing medication adherence in patients with chronic heart failure.

Design, Methods, and Results: We conducted a systematic review of randomized controlled trials searching for all-language publications in electronic databases (MEDLINE, CINAHL, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO) to the end of March 2015. Trials describing interventions intended to enhance adherence to self-administered medications in the treatment of heart failure were eligible. Two independent reviewers examined lists of retrieved articles extracting study characteristics and results for adherence. Methodological quality was examined using the Cochrane Collaboration risk of bias tool. Studies were critically reviewed and assessed for validity of their findings. From the initial 1,801 identified papers, 21 trials, containing data on 4,346 patients (mean ages, 56-85 years), were included. The median sample size was 148 patients (range, 50-902); the median follow-up time was 9 months with 9 of the 21 (43%) studies having follow-up times of s6 months. Medication adherence improvement was reported in 8 of 21 trials, the majority (5/8) categorized as enhanced direct contact. Heterogeneity of interventions and outcome measures precluded meta-analysis of results.

Conclusion: The current literature does not confer reliable conclusions regarding the best intervention techniques to improve heart failure medication adherence