High medication adherence in PAH and CTEPH patients varied from 40% to 94% across studies and was associated with reduced hospitalization rates, inpatient stays, outpatient visits, and costs.
Systematic Review (n=22,675)
What are the rates, associated factors, and clinical outcomes of medication adherence in patients with PAH or CTEPH?
High medication adherence in PAH and CTEPH patients is associated with improved clinical outcomes and reduced healthcare utilization, highlighting the need to address factors like treatment frequency and co-payments.
INTRODUCTION: Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are life-threatening conditions that can progress to death without treatment. Although strong medication adherence (MA) is known to enhance outcomes in chronic illnesses, its association with PAH and CTEPH was sporadically explored. This study aims to examine the MA of patients with PAH or CTEPH, identify factors associated with low adherence and explore the resulting outcomes. METHODS: A systematic review was conducted by searching multiple databases (Medline, Embase, Cochrane Central, ClinicalTrials.gov, Scopus, Web of Science and Google Scholar) from 6 March 1998 to 6 July 2023. We included studies reporting MA as primary or secondary end-points. Study selection, data extraction and methodological quality assessment were performed in duplicate. RESULTS: 20 studies involving 22 675 patients met the inclusion criteria. Heterogeneity was observed, particularly in the methods employed. MA means ranged from 0.62 to 0.96, with the proportion of patients exhibiting high MA varying from 40% (95% CI 35-45%) to 94% (95% CI 88-97%). Factors associated with low adherence included increased treatment frequency, time since diagnosis and co-payment. High MA seems to be associated with reduced hospitalisation rates, inpatient stays, outpatient visits and healthcare costs. CONCLUSIONS: This systematic review underscores the heterogeneity of MA across studies. Nevertheless, the findings suggest that high MA could improve patients' clinical outcomes and alleviate the economic burden. Identifying factors consistently associated with poor MA could strengthen educational efforts for these patients, ultimately contributing to improved outcomes.
Bozec et al. (2024) conducted a systematic review in Pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) (n=22,675). Medication adherence was evaluated on Medication adherence. High medication adherence in PAH and CTEPH patients varied from 40% to 94% across studies and was associated with reduced hospitalization rates, inpatient stays, outpatient visits, and costs.