Hou Qiaoling, Zhao Yuhan, Wu Ying
School of Nursing, Capital Medical University, Beijing, China.
J Glob Health. 2025 May 9;15:04145. doi: 10.7189/jogh.15.04145.
The role of medication adherence trajectories in the clinical outcomes in patients with cardiovascular diseases (CVDs) remains unclear. We aimed to analyse the impact of different medication adherence trajectories on mortality and other key clinical outcomes in patients with CVDs.
We identified longitudinal cohort studies that reported the association between medication adherence trajectories and clinical outcomes in patients with CVDs by conducting a comprehensive search of the Cochrane Library, PubMed, Embase, CINAHL, and Web of Science databases, without applying language restrictions in August 2024. We pooled the published hazard ratios and 95% confidence intervals using random effects models and assessed potential bias through Egger regression analysis.
In this meta-analysis, we included nine cohorts with 226 203 patients with a mean age of 66.1 years and a maximum follow-up of five years. Eight of the nine studies used the proportion of days covered to assess medication adherence. We identified four distinct medication adherence trajectories: persistent adherence, persistent nonadherence, gradually increasing adherence, and gradually declining adherence. Compared to persistent adherence, persistent nonadherence was associated with significantly higher risks of all-cause mortality, major adverse cardiovascular events (MACE), and recurrent venous thromboembolism, with risk increases ranging from 32% to nearly three times higher. Gradually increasing adherence was associated with a 26% higher risk of mortality and a 22% increased risk of MACE. In the group with gradually declining adherence, the risk of MACE increased by 24%, while the risk of major bleeding decreased by 43%. The overall risk of bias was low. Sensitivity analyses confirmed the consistency and robustness of these findings.
This study underscores the substantial benefits of maintaining persistent adherence to prescribed medication regimens for patients with CVDs. Conversely, persistent nonadherence significantly elevates the risk of adverse clinical outcomes.
PROSPERO: CRD42023456395.
药物依从性轨迹在心血管疾病（CVD）患者临床结局中的作用尚不清楚。我们旨在分析不同的药物依从性轨迹对CVD患者死亡率和其他关键临床结局的影响。
我们通过全面检索Cochrane图书馆、PubMed、Embase、CINAHL和Web of Science数据库，确定了报告CVD患者药物依从性轨迹与临床结局之间关联的纵向队列研究，检索时间为2024年8月，不设语言限制。我们使用随机效应模型汇总已发表的风险比和95%置信区间，并通过Egger回归分析评估潜在偏倚。
在这项荟萃分析中，我们纳入了9个队列，共226203例患者，平均年龄66.1岁，最长随访5年。9项研究中有8项使用覆盖天数比例来评估药物依从性。我们确定了4种不同的药物依从性轨迹：持续依从、持续不依从、逐渐增加依从和逐渐下降依从。与持续依从相比，持续不依从与全因死亡率、主要不良心血管事件（MACE）和复发性静脉血栓栓塞的风险显著更高相关，风险增加范围从32%到近3倍。逐渐增加依从与死亡率风险高26%和MACE风险增加22%相关。在逐渐下降依从组中，MACE风险增加24%，而大出血风险降低43%。总体偏倚风险较低。敏感性分析证实了这些发现的一致性和稳健性。
本研究强调了CVD患者持续坚持规定药物治疗方案的巨大益处。相反，持续不依从会显著提高不良临床结局的风险。
PROSPERO：CRD42023456395。
