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

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

doi:10.1016/j.ijcrp.2023.200229

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

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

Authors

Lemlem Gebremedhin Gebremichael^{1

2}, Stephanie Champion^{1

2}, Katie Nesbitt^{1

2}, Vincent Pearson³, Norma B Bulamu⁴, Hila A Dafny^{1

2}, Shelda Sajeev^{5

6}, Maria Alejandra Pinero de Plaza^{1

2

7}, Joyce S Ramos¹, Orathai Suebkinorn¹, Aarti Gulyani¹, Lemma N Bulto^{1

2}, Alline Beleigoli^{1

2}, Jeroen M Hendriks^{1

2

8}, Sonia Hines^{2

9}, Robyn A Clark^{1

2}; NHMRC CHAP Project Team

Affiliations

¹ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.
² Mparntwe Centre for Evidence in Health, Flinders University: A JBI Centre of Excellence, Australia.
³ JBI, School of Public Health, The University of Adelaide, Australia.
⁴ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
⁵ Centre for Artificial Intelligence Research and Optimisation (AIRO), Torrens University, Adelaide, South Australia, Australia.
⁶ College of Science and Engineering, Flinders University, Adelaide, SA, Australia.
⁷ National Health and Medical Research Council, Transdisciplinary Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia.
⁸ Centre for Heart Rhythm Disorders, University of Adelaide and the Royal Adelaide Hospital, Adelaide, SA, Australia.
⁹ Flinders Rural and Remote Health, NT. College of Medicine and Public Health, Flinders University, Australia.

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.

Keywords: Cardiac rehabilitation; Clinical outcomes; Effectiveness; Medication adherence; Standard care; Systematic review.