title: Improving Treatment Adherence in Heart Failure.
abstract: Despite improved treatment options, heart failure remains the third most common cause of death in Germany and the most common reason for hospitalization. The treatment recommendations contained in the relevant guidelines have been incompletely applied in practice. The goal of this systematic review is to study the efficacy of adherence-promoting interventions for patients with heart failure with respect to the taking of medications, the implementation of recommended lifestyle changes, and the improvement in clinical endpoints.
  
  
  
  We performed a meta-analysis of pertinent publications retrieved by a systematic literature search.
  
  
  
  55 randomized controlled trials were identified, in which a wide variety of interventions were carried out on heterogeneous patient groups with varying definitions of adherence. These trials included a total of 15 016 patients with heart failure who were cared for as either inpatients or outpatients. The efficacy of interventions to promote adherence to drug treatment was studied in 24 trials; these trials documented improved adherence in 10% of the patients overall (95% confidence interval [CI]: [5; 15]). The efficacy of interventions to promote adherence to lifestyle recommendations was studied in 42 trials; improved adherence was found in 31 trials. Improved adherence to at least one recommendation yielded a long-term absolute reduction in mortality of 2% (95% CI: [0; 4]) and a 10% reduction in the likelihood of hospitalization within 12 months of the start of the intervention (95% CI: [3; 17]).
  
  
  
  Many effective interventions are available that can lead to sustained improvement in patient adherence and in clinical endpoints. Longterm success depends on patients' assuming responsibility for their own health and can be achieved with the aid of coordinated measures such as patient education and regular follow-up contacts.
authors.affiliation: Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle- Wittenberg, Halle (Saale), Institute of Health and Nursing Sciences, Martin-Luther-University Halle- Wittenberg, Halle (Saale), Asklepios Parkklinik Bad Salzungen, Carl-von-Basedow-Klinikum Saalekreis GmbH.
authors.forename: Susanne
authors.initials: S
authors.lastname: Unverzagt
authors.forename: Gabriele
authors.initials: G
authors.lastname: Meyer
authors.forename: Susanne
authors.initials: S
authors.lastname: Mittmann
authors.forename: Franziska-Antonia
authors.initials: FA
authors.lastname: Samos
authors.forename: Malte
authors.initials: M
authors.lastname: Unverzagt
authors.forename: Roland
authors.initials: R
authors.lastname: Prondzinsky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D005260:Female; D006293:Health Promotion / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality* / Q000523:psychology; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011785:Quality Assurance, Health Care; D058996:Quality Improvement / Q000592:standards / Q000706:statistics & numerical data*; D017010:Reminder Systems / Q000706:statistics & numerical data; D040242:Risk Reduction Behavior; D015996:Survival Rate; D017216:Telemedicine / Q000706:statistics & numerical data; D016903:Drug Monitoring
chemical_list: D002316:Cardiotonic Agents