Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 8, 2020
Date Accepted: Apr 11, 2021
Mobile applications to improve medication adherence in cardiovascular disease: a systematic review and meta-analysis
ABSTRACT
Background:
Adherence rates to preventative medication for cardiovascular disease (CVD) are reported to be 57% and approximately 9% of all CVD events in Europe are attributable to poor medication adherence. Mobile health (mHealth) technologies, particularly mobile applications (apps), have the potential to improve medication adherence and clinical outcomes.
Objective:
To assess the effect of mobile healthcare apps on medication adherence and health-related outcomes in patients with CVD. To evaluate app usability and the involvement of healthcare professionals (HCPs) in their use.
Methods:
Electronic databases (MEDLINE, PubMed, Cochrane Library, CINAHL, PsycINFO, EMBASE, and Google Scholar) were searched for randomised controlled trials (RCTs), investigating app-based interventions aimed at improving medication adherence in patients with CVD. RCTs published in English from inception to January 2020 were reviewed. The Cochrane Risk of Bias tool was used to assess bias. PROSPERO registration CRD42019121385.
Results:
Fifteen RCTs, published within the last six years, were included. Intervention duration ranged from one to 12 months and sample sizes from 24 to 412. Eleven RCTs involved HCPs, mainly doctors and nurses, with the app-based interventions. Apps had mixed functionality: two used education; six were reminders; and seven were combined with educational support. Twelve RCTs reported medication adherence as the primary outcome; most commonly self-reported adherence. Apps significantly improved medication adherence rates (by an average of 11%) in eight RCTs compared to usual care. Five RCTs assessed clinical outcomes and reported a trend toward improvement in blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) level in the intervention arm. Of the four RCTs that evaluated app-usability, all were reported as easy-to-use.
Conclusions:
Apps tend to increase medication adherence, but interventions varied widely in design, content and delivery. Further large-scale studies should focus on identifying the essential active components of successful apps. Clinical Trial: Not applicable
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