How is patient adherence to preventative treatment strategies measured in secondary prevention of ASCVD?
There is a lack of a gold standard and significant inconsistency in how adherence to secondary prevention strategies is measured in ASCVD patients, with unspecified patient-reported outcomes being the most common.
Objective Atherosclerotic cardiovascular disease (ASCVD) is the main cause of death globally, but is by and large a preventable disease. We wished to identify, categorise and map adherence measurements of preventative treatment strategies in patients with ASCVD. Design and data sources We conducted a scoping review according to the Joanna Briggs Institue (JBI) methodology and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search was performed in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and EMBASE (Elsevier Biomedical Research database). The search was conducted in May 2023 and updated in November 2024. Eligibility criteria Observational studies pertaining to major types of ASCVD and related preventive treatment with reported adherence measures in adults over the age of 18 were included in this review. Data extraction and synthesis Title and abstract and subsequent full-text review were performed by two independent reviewers in duplicate. We presented data from the included 108 studies and synthesised the results in an overview of the most commonly used adherence measurements according to ASCVD category. Results A total of 108 records met the inclusion criteria. ASCVD populations included ranged in age from 40 to 91 years, with a male predominance (85%). Medication adherence was mostly reported by the proportion of patients taking their medication (15 studies, 14%) or the proportion of days covered (12 studies, 11%). Among the 108 included studies, 67 (62%) reported on medication adherence, 65 (60%) on smoking cessation, 39 (36%) on low-density lipoprotein cholesterol guideline adherence, 39 (36%) on exercise, 17 (16%) on diet and 11 (10%) on alcohol abstinence. Unspecified patient-reported outcome measures (PROMs) were the most used method for assessing medication adherence, reported in 15 studies (22%). Conclusion Medication adherence was the most frequently assessed domain in secondary prevention of ASCVD, with unspecified PROMs being the most applied measurement approach. Lack of a gold standard combined with inconsistent adherence measures across studies of ASCVD continues to pose a significant challenge for evaluating treatment quality.
Glud et al. (Sun,) studied this question.