Educational programmes for improving medication adherence among older adults with coronary artery disease: A systematic review and meta-analysis

Background: Coronary artery disease is the leading cause of death worldwide. Adhering to coronary artery disease medications is the priority of its treatment. Medication adherence is suboptimal among older adults with coronary artery disease. Educational programmes are used and recommended in improving medication adherence among older adults with coronary artery disease. The evidence about the effects of educational programmes on medication adherence among older adults with coronary artery disease is, however, limited.

Aim: To evaluate the effects of educational programmes designed for improving medication adherence among older adults with coronary artery disease.

Methods: 12 English databases and five Chinese databases were searched from database inception to January 2024. Randomised controlled trials examining the effects of educational programmes for improving medication adherence among older adults (aged 60 years old or above) with coronary artery disease (including myocardial infarction, stable or unstable angina, undergoing percutaneous coronary intervention, or undergoing coronary artery bypass grafting) were included. The quality of the included studies was assessed by the Cochrane Risk of Bias Tool v2. Meta-analysis was conducted using random-effect models with Review Manager 5.3. Narrative synthesis was conducted if the results of the included studies were not appropriate or possible for meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of evidence.

Results: 5607 records were retrieved, and 5600 records were excluded. Six randomised controlled trials were included. The results showed that educational programmes could significantly improve medication adherence at two to six months post-intervention (standardised mean difference (SMD): 1.13, 95 % confidence interval (CI): 0.33 to 1.94, P = 0.006, Moderate certainty of evidence), but there was no significant evidence to support their effect on medication adherence within one-month post-intervention (SMD: 2.18, 95 % CI: -1.22, 5.58, P = 0.21, Low certainty of evidence). Narrative synthesis found that the educational programmes potentially improved medication adherence over six months post-intervention, understanding of coronary artery disease and related medications, and medication management capacity.

Conclusions: Educational programmes could significantly improve medication adherence among older adults with coronary artery disease at two to six months post-intervention, and potentially improve medication adherence over six months post-intervention. The effect on medication adherence within one-month post-intervention was inconclusive. Designing the educational programmes with theoretical frameworks and refined components helps address their complex health needs. More rigorous evaluation of the effects of educational programmes on medication adherence of the older adults with coronary artery disease is warranted.

Registration: PROSPERO (Registration Number: CRD42024472344; Registration name: Educational programmes for improving medication adherence among older adults with coronary artery disease: A systematic review).