Interventions to Enhance Adherence to Guideline Recommendations in Secondary and Tertiary Prevention of Heart Failure: A Systematic Review

Background: Heart Failure (HF) is a major clinical and public health problem with strong implications for quality of life and high socioeconomic impact due to costs of treatment. Patients being treated according to the present recommendations show improved survival and lower rehospitalization rates, but poor adherence is considered to be a critical barrier for treatment success. Therefore, we want to investigate interventions aimed at improving adherence of patients to recommendations on HF, e.g. how do physicians approach their patients’ problems, provide information and involve individual values and preferences in the process of decision making? To date, many randomized trials have investigated interventions to reduce barriers for adherence, but a systematic review of these interventions is needed. Methods: This systematic review should evaluate the efficacy and effectiveness of interventions to enhance patient adherence to guideline recommendations in secondary and tertiary prevention of HF. Methodology follows the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. We will include only randomized controlled trials and classify interventions according to their active component as interventions concerning the provider, patient education, and patient reminder, promotion of patients’ self-management, organizational change or technical solutions. The primary outcome measure is patient adherence; important patient outcomes such as quality of life, mortality, morbidity, hospital admissions and readmissions, days in hospital, and costs are added as secondary outcomes. A random-effects meta-regression model will be used to simultaneously assess the influence of different strategies on patient adherence. Analyses on heterogeneity will include pre-defined methodological and clinical sources of heterogeneity. Conclusion: This systematic review should identify major components of successful interventions aimed to foster the therapeutic adherence and/or self-managing abilities of patients. Without appropriate strategies for promoting adherence the transfer of guideline recommendations into daily practice is hindered by many obstacles that reduce the desired health outcome. Systematic review registration: PROSPERO CRD42014009477.