The effectiveness of interventions in managing treatment adherence in adult heart transplant patients: a systematic review

Abstract

Over the past 20 years, solid organ transplantation has evolved from experimental treatments to an effective alternative for the treatment of various diseases, including heart failure. Treatment non-adherence is a limiting factor for the success of heart transplants. A systematic review of the evidence is needed to examine the effectiveness of interventions for managing adherence to treatment in heart transplant patients. The primary objective of this systematic review was to synthesize the best available evidence regarding interventions for managing adherence to pharmacological and non-pharmacological treatments in heart/heart-lung transplant patients. This review considered primary studies that included patients 18 years old or older, who had undergone heart or heart-lung transplantation (regardless of gender, ethnicity, comorbidities or whether they had received other treatments or not) who were receiving pharmacological and non-pharmacological treatments.This review considered studies that evaluated the effectiveness of interventions in managing adherence to pharmacological or non-pharmacological treatments among adult heart/heart-lung transplant patients. Primary studies comparing standard care with any type of intervention to maintain treatment adherence were considered.This review considered any experimental study design including randomized controlled trials; other research designs, such as non-randomized controlled trials and before and after studies, were also considered for inclusion.The primary outcome considered was patient adherence to pharmacological or non-pharmacological treatments by means of objective or self-report assessment. Published and unpublished studies in English, Portuguese and Spanish were searched in electronic databases. Searches were completed in January 2014. Two independent reviewers, using the standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument, assessed methodological quality. Data were extracted using the standardized data extraction tool from Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Statistical pooling was not possible due to substantial heterogeneity of the studies; therefore data were presented as a narrative summary. Three quasi-experimental studies were included in this review. One study found that a dose reduction of immunosuppressive medications from a twice-daily to a once-daily regimen had a positive impact on treatment adherence; one found no significant difference in treatment adherence between patients who received educational intervention conducted in a teaching laboratory and those who received standard care; the third one also reported no significant difference in outcomes between a multifaceted intervention consisting of internet-based interactive workshops and standard care. The current best evidence to guide decisions regarding interventions to manage treatment adherence in heart transplant patients is limited. There is weak evidence that psycho-educational interventions (other than the standard care) has a positive impact on adherence and that decreasing the complexity of the treatment regimen by reducing the daily dose of the immunosuppressant drug improves adherence in heart transplant patients.