The use of technology to improve medication adherence in heart failure patients: a systematic review of randomised controlled trials

Abstract

Background

Heart failure is an ever-growing contributor to morbidity and mortality in the ageing population. Medication adherence rates among the HF population vary widely in the literature, with a reported range of 10–98%. Technologies have been developed to improve adherence to therapies and other clinical outcomes.

Aims

This systematic review aims to investigate the effect of different technologies on medication adherence in patients with heart failure. It also aims to determine their impact on other clinical outcomes and examine the potential of these technologies in clinical practice.

Methods

This systematic review was conducted using the following databases: PubMed Central UK, Embase, MEDLINE, CINAHL Plus, PsycINFO and Cochrane Library until October 2022. Studies were included if they were randomised controlled trials that used technology to improve medication adherence as an outcome in heart failure patients. The Cochrane Collaboration's Risk of Bias tool was used to assess individual studies. This review was registered with PROSPERO (ID: CRD42022371865).

Results

A total of nine studies met the inclusion criteria. Two studies showed statistically significant improvement in medication adherence following their respective interventions. Eight studies had at least one statistically significant result in the other clinical outcomes it measured, including self-care, quality of life and hospitalisations. All studies that evaluated self-care management showed statistically significant improvement. Improvements in other outcomes, such as quality of life and hospitalisations, were inconsistent.

Conclusion

It is observable that there is limited evidence for using technology to improve medication adherence in heart failure patients. Further studies with larger study populations and validated self-reporting methods for medication adherence are required.

Keypoints

• The evidence in this review shows the potential for technology use in practice to improve health outcomes for patients with heart failure. Still, there is uncertainty in the evidence on its impact on medication adherence.

• Technologies presented in the studies are generally acceptable for participants, which is informative for future implementations into practice.

• There was a lack of high-quality studies investigating technology's use on medication adherence in heart failure. More extensive studies with improvements to study design are needed to ultimately conclude the effects on medication adherence.

Keywords:

• Medication adherence
• Heart Failure
• Technology
• Self-care management

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s40545-023-00582-9.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s40545-023-00582-9.

Acknowledgements

Not applicable.

Author contributions

Study conception and design CC, GD, ZJ, NA; database searches CC, GD, ZJ; study selection and data extraction CC, GD, ZJ.; analysis, CC, GD, ZJ.; manuscript drafting CC, GD, ZJ, NA; manuscript revision and editing CC, GD, ZJ,NA. All authors have read and agreed to the published version of the manuscript.

Funding

Not applicable.

Availability of data and materials

Further supplementary material is available on request.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors have no competing interests to declare.

Supplementary Information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.