Mobile phones may provide modest benefit in improving adherence to preventive medication for cardiovascular disease

Wednesday 28 April 2021

Vanessa Jordan

PEARLS No.

674

Clinical question

Are mobile phone interventions effective in improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults?

Bottom line

The evidence for the intervention effect on low-density lipoprotein cholesterol was of low certainty. Two of the 5 studies reporting LDL cholesterol as an outcome recorded evidence of intervention benefit, albeit of a modest size (reducing LDL cholesterol by 9.2mg/dL and 5.3mg/dL). The remaining 3 trials all had wide confidence intervals, which included no effect.

Low-certainty evidence from 4 of the 13 studies recording systolic blood pressure showed evidence of intervention benefit. The same 4 trials also demonstrated a reduction in diastolic blood pressure associated with the intervention. Again, the remaining studies had wide confidence intervals but tended towards showing small benefits.

Caveat

The studies were conducted in a range of settings, providing reasonable confidence in the applicability of results across different settings. Given the inclusion criteria required trials to have a minimum follow-up of 1 year, the results are applicable to longer‐term, sustained medication adherence behaviours and outcomes. Few studies reported on fatal or non‐fatal cardiovascular events, so the authors were unable to establish whether modest benefits observed in individual trials for cholesterol and blood pressure translated into patient‐relevant outcomes.

Context

CVD is a major cause of disability and mortality globally. Premature fatal and non‐fatal CVD is considered to be largely preventable through the control of risk factors by lifestyle modification and preventive medication. Lipid‐lowering and antihypertensive drug therapies for primary prevention are cost‐effective in reducing CVD morbidity and mortality among high‐risk people and are recommended by international guidelines. However, adherence to medication prescribed for the prevention of CVD can be poor.

Cochrane Systematic Review

Palmer MJ, et al. Mobile phone‐based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults. Cochrane Database Syst Rev 2018;6(6):CD012675. This review contains 14 trials with a total of 25,633 participants.

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