Multimodal Interventions to Enhance Adherence to Secondary Preventive Medication after Stroke: A Systematic Review and Meta-Analyses

被引:14
作者
Al AlShaikh, Sukainah [1 ]
Quinn, Terry [1 ]
Dunn, William [1 ]
Walters, Matthew [1 ]
Dawson, Jesse [1 ]
机构
[1] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland
关键词
Adherence; Intervention; Prevention; Secondary; Stroke; TIA; VASCULAR EVENTS; RISK; INITIATION; PROGRAM; PATIENT; MANAGEMENT; THERAPIES; DISCHARGE; IMPROVE; TRIAL;
D O I
10.1111/1755-5922.12176
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IntroductionNonadherence 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. MethodsWe 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. ResultsFrom 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]). ConclusionInterventions 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.
引用
收藏
页码:85 / 93
页数:9
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