Evidence map›Paper›PMID 27738515›Full record

ArticleOpen heart

Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: a systematic review.

Amitava Banerjee, Shweta Khandelwal, Lavanya Nambiar, Malvika Saxena, Victoria Peck, Mohammed Moniruzzaman, Jose Rocha Faria Neto, Katherine Curi Quinto, Andrew Smyth, Darryl Leong and 1 more

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In one paragraph

Article in Open heart. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

27 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Amitava BanerjeeFarr Institute of Health Informatics Research, University College London , London , UK.
Shweta KhandelwalPublic Health Foundation of India , New Delhi , India.
Lavanya NambiarPublic Health Foundation of India , New Delhi , India.
Malvika SaxenaPublic Health Foundation of India , New Delhi , India.
Victoria PeckPopulation Health Research Institute, McMaster University , Hamilton, Ontario , Canada.
Mohammed MoniruzzamanWHO Bangladesh, Dhaka , Bangladesh.
Jose Rocha Faria NetoPontifícia Universidade Católica do Paraná (PUCPR) , Curitiba , Brazil.
Katherine Curi QuintoInstituto de Nutrición y Tecnología de los Alimentos, Asociación Kausasunchis-ADEK Perú, Lima , Peru.
Andrew SmythPopulation Health Research Institute, McMaster University , Hamilton, Ontario , Canada.
Darryl LeongPopulation Health Research Institute, McMaster University , Hamilton, Ontario , Canada.
José Pablo WerbaCentro Cardiologico Monzino, IRCCS , Milan , Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSecondary prevention is cost-effective for cardiovascular disease (CVD), but uptake is suboptimal. Understanding barriers and facilitators to adherence to secondary prevention for CVD at multiple health system levels may inform policy.

objectivesTo conduct a systematic review of barriers and facilitators to adherence/persistence to secondary CVD prevention medications at health system level.

methodsIncluded studies reported effects of health system level factors on adherence/persistence to secondary prevention medications for CVD (coronary artery or cerebrovascular disease). Studies considered at least one of β blockers, statins, angiotensin-renin system blockers and aspirin. Relevant databases were searched from 1 January 1966 until 1 October 2015. Full texts were screened for inclusion by 2 independent reviewers.

resultsOf 2246 screened articles, 25 studies were included (12 trials, 11 cohort studies, 1 cross-sectional study and 1 case-control study) with 132 140 individuals overall (smallest n=30, largest n=63 301). 3 studies included upper middle-income countries, 1 included a low middle-income country and 21 (84%) included high-income countries (9 in the USA). Studies concerned established CVD (n=4), cerebrovascular disease (n=7) and coronary heart disease (n=14). Three studies considered persistence and adherence. Quantity and quality of evidence was limited for adherence, persistence and across drug classes. Studies were concerned with governance and delivery (n=19, including 4 trials of fixed-dose combination therapy, FDC), intellectual resources (n=1), human resources (n=1) and health system financing (n=4). Full prescription coverage, reduced copayments, FDC and counselling were facilitators associated with higher adherence.

conclusionsHigh-quality evidence on health system barriers and facilitators to adherence to secondary prevention medications for CVD is lacking, especially for low-income settings. Full prescription coverage, reduced copayments, FDC and counselling may be effective in improving adherence and are priorities for further research.

Identifiers

PMID27738515
PMCPMC5030589

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.