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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Adherence to cardiovascular medications in the South Asian population: A systematic review of current evidence and future directions
Julia M Akeroyd, Winston J Chan, Ayeesha K Kamal, Latha Palaniappan, Salim S Virani
Julia M Akeroyd, Winston J Chan, Salim S Virani, the Health Policy, Quality and Informatics Program, Michael E DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, TX 77030, United States
Ayeesha K Kamal, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
Latha Palaniappan, General Medicine Disciplines, Stanford School of Medicine, Stanford, CA 94304, United States
Salim S Virani, Health Services Research and Development, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX 77030, United States
Salim S Virani, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
Salim S Virani, Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, United States
Author contributions: Akeroyd JM, Chan WJ, Kamal AK, Palaniappan L and Virani SS conceptualized and designed the review together; Akeroyd JM and Chan WJ conducted the review and drafted the initial manuscript; all authors reviewed and approved the final manuscript as submitted.
Supported by American Heart Association Beginning Grant-in-Aid, No. 14BGIA20460366; the American Diabetes Association Clinical Science and Epidemiology award (1-14-CE-44); the Baylor College of Medicine Center for Globalization Award; and the Houston VA HSR&D Center for Innovations grant, No. HFP 90-020.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: No additional data are available other than articles cited in this review.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Salim S Virani, MD, PhD, Health Services Research and Development, Michael E DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030, United States. virani@bcm.edu
Telephone: +1-713-4404410 Fax: +1-713-7487359
Received: May 29, 2015
Peer-review started: June 2, 2015
First decision: July 3, 2015
Revised: July 24, 2015
Accepted: September 29, 2015
Article in press: September 30, 2015
Published online: December 26, 2015
AIM: To review methods of assessing adherence and strategies to improve adherence to cardiovascular disease (CVD) medications, among South Asian CVD patients.
METHODS: We conducted a systematic review of English language studies that examined CVD medication adherence in South Asian populations from 1966 to April 1, 2015 in SCOPUS and PubMed. Working in duplicate, we identified 61 studies. After exclusions, 26 studies were selected for full text review. Of these, 17 studies were included in the final review. We abstracted data on several factors including study design, study population, method of assessing adherence and adherence rate.
RESULTS: These studies were conducted in India (n = 11), Pakistan (n = 3), Bangladesh (n = 1), Nepal (n = 1) and Sri Lanka (n = 1). Adherence rates ranged from 32%-95% across studies. Of the 17 total publications included, 10 focused on assessing adherence to CVD medications and 7 focused on assessing the impact of interventions on medication adherence. The validated Morisky Medication Adherence Scale (MMAS) was used as the primary method of assessing adherence in five studies. Three studies used validated questionnaires similar to the MMAS, and one study utilized Medication Event Monitoring System caps, with the remainder of the studies utilizing pill count and self-report measures. As expected, studies using non-validated self-report measures described higher rates of adherence than studies using validated scale measurements and pill count. The included intervention studies examined the use of polypill therapy, provider education and patient counseling to improve medication adherence.
CONCLUSION: The overall medication adherence rates were low in the region, which suggest a growing need for future interventions to improve adherence.
Core tip: The overall adherence rate in South Asia is quite low. Only 7 of 17 publications conducted interventions geared toward improving adherence. Even fewer (n = 3) utilized community health care workers, which provide a unique resource in these resource constrained environments. Just over half of the studies found in our review utilized validated or gold standard methods (n = 9) with the rest using non-validated self-reported measures. Additionally, there was a lack of usage of technology despite the majority of these countries benefitting from a high cell phone density.
