JMIR Publications

ABSTRACT

Background:

Suboptimal adherence to cardiac pharmacotherapy recommended by the guidelines after acute coronary syndrome (ACS) has been recognized and is associated with adverse outcomes. Several randomized controlled trials (RCTs) have shown that eHealth technologies are useful in reducing cardiovascular risk factors. However, little is known about the effect of eHealth interventions on medication adherence in patients following ACS.

Objective:

To examine the efficacy of the eHealth interventions on medication adherence to selected five cardioprotective medication classes in patients with ACS.

Methods:

A systematic literature search was conducted to identify RCTs that evaluated the effectiveness of eHealth technologies, including text messaging, smartphone applications, or web-based applications, to improve medication adherence in patients after ACS. A pooled meta-analysis was performed using a fixed effect Mantel-Haenszel model and assessed the medication adherence to the medications of statins, aspirin, P2Y12 inhibitors, angiotensin-convertase enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), and β-blockers.

Results:

We identified five RCTs, applicable to 4100 participants (2093 intervention v 2007 control), for inclusion in the meta-analysis. In patients who recently had an ACS, compared to control group, the use of eHealth intervention was not associated with improved adherence to statins at different time points (risk difference [RD]: -0.01; 95% CI: -0.03 – 0.03 at 6-month and -0.02, -0.05 – 0.02 at 12-month), P2Y12 inhibitors (-0.01, -0.04 – 0.02 and -0.01, -0.03 – 0.02), aspirin (0.00, -0.06 – 0.07 and -0.00, -0.07 – 0.06), ACEIs/ARBs (-0.01, -0.04 – 0.02 and 0.01, -0.04 – 0.05), and β-blockers (0.00, -0.03 – 0.03 and -0.01, -0.05 – 0.03). The intervention was also no associated with improved adherence irrespective of the adherence assessment method employed (self-report or objective).

Conclusions:

This review identified limited evidence on the effectiveness of eHealth interventions on adherence to guideline-recommended medications after ACS. While the pooled analyses suggested lack of effectiveness of such interventions on adherence improvement, further studies are warranted to better understand the role of different eHealth approaches in post-ACS context.