Background and Purpose: Non-adherence to secondary preventative medications after stroke is common. Numerous strategies exist to promote adherence and we performed a systematic review and meta-analysis of these strategies after stroke.
Methods: We systematically reviewed MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Databases, and the Web of Knowledge for studies of interventions to enhance adherence to secondary preventative medication after stroke. We followed PRISMA guidance. We performed meta-analysis where data allowed.
Results: We carried out the search in March - April 2014 and identified a total of 12,237 titles. Title review identified 143 papers for abstract review, 57 were retrieved for full-text review and 17 met our eligibility criteria. The total number of participants enrolled was 3942 patients with stroke/TIA (2090 participants were finally analysed in the intervention group and 824 participants as controls). We separated findings of included studies depending on secondary preventative medication classes reported. In the meta-analyses, we included three studies reported the effect of intervention to the overall secondary preventative medications regimen, six studies effect of intervention reported adherence to blood-pressure lowering drugs, and three studies reported effect of intervention on adherence to lipid-lowering drugs. There was no sufficient number of studies reported adherence to antithrombotic drugs after stroke. Forest-plots were constructed for each analysis (figure).
Conclusion: Interventions in identified studies lead to improvement in adherence to secondary preventative medication after stroke. However, existing data is limited thus need to be interpreted with caution.
Figure: Forest plots of meta-analyses of intervention studies (Favours A = Control, Favours B = Intervention)