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 Seven databases and clinical trial registries were searched for published and unpublished articles from database inception to 09 Feb 2022.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