Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Mar 3, 2024
Open Peer Review Period: Mar 2, 2024 - Mar 20, 2024
Date Accepted: May 30, 2024
(closed for review but you can still tweet)
Effectiveness of eHealth Interventions in Improving Medication Adherence among Cardiovascular Disease Patients: A Network Meta-analysis
ABSTRACT
Background:
Background:
Non-adherence to medication among cardiovascular patients undermines the desired therapeutic outcomes. Electronic health (eHealth) interventions emerge as promising strategies to effectively tackle this issue.
Objective:
Objective:
The aim of this study was to conduct a network meta-analysis (NMA) to compare and rank the efficacy of various eHealth interventions in improving medication adherence among patients with cardiovascular diseases (CVDs).
Methods:
Methods:
A systematic search strategy was conducted in PubMed, Embase, Web of Science, Cochrane, China National Knowledge Infrastructure Library (CNKI), China Science and Technology Journal Database (Weipu), WanFang databases to search randomized controlled trials (RCTs) published from their inception on January 15th, 2024. We carried out a frequentist NMA to compare the efficacy of various eHealth interventions. The quality of the literature was assessed using the risk of bias tool from the Cochrane Handbook (version 2.0), and extracted data were analyzed using Stata16.0 and RevMan5.4 software.
Results:
Results:
A total of 21 RCTs with 3,904 patients were enrolled. The network meta-analysis revealed that combined intervention [SMD=0.89; 95% CI (0.22, 1.57)], telephone support [SMD=0.68; 95% CI (0.02, 1.33)], telemonitoring intervention [SMD=0.70; 95% CI (0.02, 1.39)], APP intervention [SMD=0.65; 95% CI (0.01, 1.30)] were statistically superior to usual care. However, short messaging service compared to usual care showed no statistical difference. Notably, the combined intervention, with a surface under the cumulative ranking curve (SUCRA) of 79.3%, appeared to be the most effective option for CVDs patients. Regarding systolic blood pressure and diastolic blood pressure outcomes, the combined intervention also had the highest probability of being the best intervention.
Conclusions:
Conclusions:
The research shows that combined intervention possessed the greatest likelihood of being the best eHealth intervention to improve medication adherence in patients with CVDs, along with the suboptimal telemonitoring intervention, followed by telephone support and APP intervention. These results of the network meta-analysis could be important evidence-based for clinical healthcare providers to improve patients’ medication adherence. Given the differences in the design and implementation of eHealth interventions, more large, well-designed multicentre trials is required in the future to explore. Clinical Trial: It has been registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY), with the registration number INPLASY2023120063.
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