Multimodal interventions to enhance adherence to secondary preventive medication after stroke: a systematic review and meta-analyses

Al AlShaikh, S., Quinn, T. , Dunn, W., Walters, M. and Dawson, J. (2016) Multimodal interventions to enhance adherence to secondary preventive medication after stroke: a systematic review and meta-analyses. Cardiovascular Therapeutics, 34(2), pp. 85-93. (doi:10.1111/1755-5922.12176)

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Abstract

Summary: Introduction: Nonadherence to secondary preventative medications after stroke is common and is associated with poor outcomes. Numerous strategies exist to promote adherence. We performed a systematic review and meta-analysis to describe the efficacy of strategies to improve adherence to stroke secondary prevention. Methods: We created a sensitive search strategy and searched multiple electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, CENTRAL, and Web of Knowledge) for studies of interventions that aimed to enhance adherence to secondary preventative medication after stroke. We assessed quality of included studies using the Cochrane tool for assessing risk of bias. We performed narrative review and performed meta-analysis where data allowed. Results: From 12,237 titles, we included seventeen studies in our review. Eleven studies were considered to have high risk of bias, 3 with unclear risk, and 3 of low risk. Meta-analysis of available data suggested that these interventions improved adherence to individual medication classes (blood pressure-lowering drugs – OR, 2.21; 95% CI (1.63, 2.98), [P < 0.001], lipid-lowering drugs – OR, 2.11; 95% CI (1.00, 4.46), [P = 0.049], and antithrombotic drugs – OR, 2.32; 95% CI (1.18, 4.56, [P = 0.014]) but did not improve adherence to an overall secondary preventative medication regimen (OR, 1.96; 95% CI (0.50, 7.67), [P = 0.332]). Conclusion: Interventions can lead to improvement in adherence to secondary preventative medication after stroke. However, existing data is limited as several interventions, duration of follow-up, and various definitions were used. These findings need to be interpreted with caution.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Quinn, Dr Terence and Dawson, Professor Jesse and Dunn, Dr William and Walters, Professor Matthew
Authors: Al AlShaikh, S., Quinn, T., Dunn, W., Walters, M., and Dawson, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cancer Sciences
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Cardiovascular Therapeutics
Publisher:Wiley
ISSN:1755-5914
ISSN (Online):1755-5922
Copyright Holders:Copyright © 2016 Wiley
First Published:First published in Cardiovascular Therapeutics 34(2):85-93
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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