心脏康复计划对心血管疾病患者药物依从性的有效性：一项系统评价和荟萃分析。

Effectiveness of cardiac rehabilitation programs on medication adherence in patients with cardiovascular disease: A systematic review and meta-analysis.

作者信息

Gebremichael Lemlem Gebremedhin, Champion Stephanie, Nesbitt Katie, Pearson Vincent, Bulamu Norma B, Dafny Hila A, Sajeev Shelda, Pinero de Plaza Maria Alejandra, Ramos Joyce S, Suebkinorn Orathai, Gulyani Aarti, Bulto Lemma N, Beleigoli Alline, Hendriks Jeroen M, Hines Sonia, Clark Robyn A

机构信息

Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.

Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia.

出版信息

Int J Cardiol Cardiovasc Risk Prev. 2023 Dec 12;20:200229. doi: 10.1016/j.ijcrp.2023.200229. eCollection 2024 Mar.

DOI:10.1016/j.ijcrp.2023.200229

PMID:38188637

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10770721/

Abstract

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 Seven databases and clinical trial registries were searched for published and unpublished articles from database inception to 09 Feb 2022.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.

摘要

背景

开展教育以提高药物依从性是心脏康复（CR）项目的核心组成部分之一。然而，关于CR项目对药物依从性有效性的证据存在矛盾。因此，我们旨在总结CR项目与标准护理相比对心血管疾病患者药物依从性的有效性。

方法

进行了一项系统评价和荟萃分析。检索了7个数据库和临床试验注册库，以查找从数据库建立至2022年2月9日发表和未发表的文章。仅纳入随机对照试验和准实验研究。由两名独立的评审人员进行筛选、提取和评估。遵循了JBI有效性评价方法和PRISMA 2020指南。使用RevMan 5.4.1版本对纳入研究进行统计荟萃分析。

结果

共纳入33项研究，16677名参与者。CR项目使药物依从性提高了14%（风险比=1.14；95%置信区间：1.07至1.22；p=0.0002），证据确定性程度较低。CR还使死亡风险降低了17%（风险比=0.83；95%置信区间：0.69至1.00；p=0.05）；初级保健和急诊科就诊次数平均差异为0.19（标准化均数差=-0.19；95%置信区间：-0.30至-0.08；p=0.0008）；生活质量提高了0.93（标准化均数差=0.93；95%置信区间：0.38至1.49；p=0.0010）。但在血脂谱方面未观察到显著差异，总胆固醇（标准化均数差=-0.26；95%置信区间：-0.44至-0.07；p=0.006）和血压水平除外。