Adherence and persistence to heart failure guideline-directed medical therapy: A systematic review of studies based on electronic healthcare data.
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| Titel: | Adherence and persistence to heart failure guideline-directed medical therapy: A systematic review of studies based on electronic healthcare data. |
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| Autoren: | Báez-Gutiérrez N; Pharmacy Department, Nuestra Señora de Valme University Hospital, Seville, Spain., Galindo-García C; Pharmacy Department, Nuestra Señora de Valme University Hospital, Seville, Spain., Rodríguez-Ramallo H; Pharmacy Department, Jerez University Hospital, Jerez, Spain. Electronic address: hector.rodriguez.sspa@juntadeandalucia.es., Sánchez-Fidalgo S; Preventive Medicine and Public Health Department, University of Seville, Seville, Spain. |
| Quelle: | Research in social & administrative pharmacy : RSAP [Res Social Adm Pharm] 2025 Dec; Vol. 21 (12), pp. 1013-1023. Date of Electronic Publication: 2025 Jul 17. |
| Publikationsart: | Journal Article; Systematic Review; Review |
| Sprache: | English |
| Info zur Zeitschrift: | Publisher: Elsevier Country of Publication: United States NLM ID: 101231974 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1934-8150 (Electronic) Linking ISSN: 15517411 NLM ISO Abbreviation: Res Social Adm Pharm Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: New York, NY : Elsevier |
| MeSH-Schlagworte: | Heart Failure*/drug therapy , Medication Adherence* , Guideline Adherence*, Humans ; Electronic Health Records ; Practice Guidelines as Topic ; Mineralocorticoid Receptor Antagonists/therapeutic use |
| Abstract: | Competing Interests: Declaration of competing interest The authors declare no conflicts of interest, financial or otherwise, related to the medications, healthcare interventions, or methodologies discussed in this article. Background: Heart failure (HF) significantly impacts global morbidity, mortality, and healthcare costs. Effective treatment involves multiple guideline-directed medical therapies, such as beta-blockers, angiotensin-converting enzyme inhibitors, and mineralocorticoid receptor antagonists, angiotensin receptor-neprilysin inhibitor and sodium-glucose cotransporter 2 inhibitors. However, medication adherence and persistence in HF patients are often suboptimal, negatively influencing clinical outcomes. This systematic review assesses medication adherence and persistence among HF patients and their relationship to clinical outcomes. Methods: A systematic review following PRISMA guidelines was conducted, evaluating observational studies utilizing electronic healthcare databases published between 1990 and 2024. Studies reporting adherence or persistence to HF pharmacological treatments, measured by pharmacy claims or electronic health records, were included. Primary adherence (initial dispensing), secondary adherence (continued refilling), and persistence (duration until medication discontinuation) were analyzed. Results: Fifty-two studies involving 2,001,178 HF patients were reviewed. No studies adequately assessed primary adherence. Secondary adherence was predominantly evaluated using Proportion of Days Covered or Medication Possession Ratio, with adherence generally below optimal levels (<80 %). Medication adherence declined significantly with increased regimen complexity and over extended periods. Persistence rates were notably lower in long-term follow-ups, especially with mineralocorticoid receptor antagonists. Higher medication adherence and persistence consistently correlated with reduced hospitalizations, emergency department visits, and mortality rates. Methodological heterogeneity across studies precluded the feasibility of a meta-analysis. Conclusions: Medication adherence and persistence among HF patients remain suboptimal, particularly with complex, multi-drug regimens and prolonged treatments. Improved adherence was correlated with better clinical outcomes, underscoring the need for standardized adherence measures and targeted interventions to enhance patient outcomes. (Copyright © 2025 Elsevier Inc. All rights reserved.) |
| Contributed Indexing: | Keywords: Adherence measures; Adherence thresholds; Electronic health records; Heart failure; Medication adherence |
| Substance Nomenclature: | 0 (Mineralocorticoid Receptor Antagonists) |
| Entry Date(s): | Date Created: 20250721 Date Completed: 20251015 Latest Revision: 20251201 |
| Update Code: | 20251201 |
| DOI: | 10.1016/j.sapharm.2025.07.005 |
| PMID: | 40691117 |
| Datenbank: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstract: | Competing Interests: Declaration of competing interest The authors declare no conflicts of interest, financial or otherwise, related to the medications, healthcare interventions, or methodologies discussed in this article.<br />Background: Heart failure (HF) significantly impacts global morbidity, mortality, and healthcare costs. Effective treatment involves multiple guideline-directed medical therapies, such as beta-blockers, angiotensin-converting enzyme inhibitors, and mineralocorticoid receptor antagonists, angiotensin receptor-neprilysin inhibitor and sodium-glucose cotransporter 2 inhibitors. However, medication adherence and persistence in HF patients are often suboptimal, negatively influencing clinical outcomes. This systematic review assesses medication adherence and persistence among HF patients and their relationship to clinical outcomes.<br />Methods: A systematic review following PRISMA guidelines was conducted, evaluating observational studies utilizing electronic healthcare databases published between 1990 and 2024. Studies reporting adherence or persistence to HF pharmacological treatments, measured by pharmacy claims or electronic health records, were included. Primary adherence (initial dispensing), secondary adherence (continued refilling), and persistence (duration until medication discontinuation) were analyzed.<br />Results: Fifty-two studies involving 2,001,178 HF patients were reviewed. No studies adequately assessed primary adherence. Secondary adherence was predominantly evaluated using Proportion of Days Covered or Medication Possession Ratio, with adherence generally below optimal levels (<80 %). Medication adherence declined significantly with increased regimen complexity and over extended periods. Persistence rates were notably lower in long-term follow-ups, especially with mineralocorticoid receptor antagonists. Higher medication adherence and persistence consistently correlated with reduced hospitalizations, emergency department visits, and mortality rates. Methodological heterogeneity across studies precluded the feasibility of a meta-analysis.<br />Conclusions: Medication adherence and persistence among HF patients remain suboptimal, particularly with complex, multi-drug regimens and prolonged treatments. Improved adherence was correlated with better clinical outcomes, underscoring the need for standardized adherence measures and targeted interventions to enhance patient outcomes.<br /> (Copyright © 2025 Elsevier Inc. All rights reserved.) |
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| ISSN: | 1934-8150 |
| DOI: | 10.1016/j.sapharm.2025.07.005 |