Impact of Cardiovascular Imaging Results on Medication Use and Adherence: A Systematic Review and Meta-Analysis.

Carl Schultz, Jack Dalla Via, Reindolf Anokye, Ben Jackson, James Dimmock, Joanne M Dickson, Lauren C Blekkenhorst, Mandy Stanley, Joshua R Lewis, Jonathan M Hodgson, Mie Schæffer

Journal: American journal of preventive medicine 2024;67(4):606-617

PMID: 38876293

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Abstract

INTRODUCTION

Cardiovascular imaging results offer valuable information that can guide health decisions, but their impact on medication use and adherence is unclear. This systematic review and meta-analysis aimed to determine the downstream impact of cardiovascular imaging results on medication use and adherence.

METHODS

Searches were conducted across databases, including MEDLINE, PsychINFO, EMBASE, and relevant references up to 2024. Data were extracted from studies comparing outcomes for individuals with diseased versus normal arteries and trials comparing outcomes for individuals who were provided imaging results versus those with no access to imaging results and analysed in 2023 and 2024. Pooled odds ratios (ORs) for outcomes were calculated.

RESULTS

The analysis included 29 studies with 24 contributing data points. Initiation (OR:2.77;95% CI:1.82-4.20) and continuation (OR:2.06;95% CI:1.28-3.30) of lipid-lowering medications (LLMs), antihypertensives (OR:2.02;95% CI:1.76-2.33), and antiplatelets (OR:2.47;95% CI:1.68-3.64) were significantly higher in individuals with diseased arteries. The proportion of individuals on LLM increased by 2.7-fold in those with diseased arteries and 1.5-fold in those with normal arteries post-screening. The proportion on LLM increased by 4.2 times in the imaging group and 2.2 times in the "no imaging group" post-screening. There was a significant increase in LLM initiation (OR:2.37;95% CI: 1.17-4.79) in the imaging group, but medication continuation did not significantly differ between the imaging and "no imaging group".

DISCUSSION

Cardiovascular imaging results can prompt initiation of medications, particularly lipid-lowering medications, reflecting a proactive response to identified risk factors. However, evidence regarding medication continuation is mixed, and further research is required.

Address: School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia. Electronic address: [email protected].; Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia.; Department of Psychology, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia.; Telethon Kids Institute, Perth, Western Australia, Australia; School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia.; Cardiology Department, Royal Perth Hospital, Perth, Western Australia, Australia; Medical School, The University of Western Australia, Perth, Western Australia, Australia.; Department of Cardiology, Odense University Hospital, Denmark.; Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia; School of Arts and Humanities (Psychology Discipline), Edith Cowan University, Joondalup, Western Australia, Australia; Department of Psychological Science, University of Liverpool, UK.; Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia; Medical School, The University of Western Australia, Perth, Western Australia, Australia.; School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.; Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia; Medical School, The University of Western Australia, Perth, Western Australia, Australia; Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.

DOI: 10.1016/j.amepre.2024.06.008

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MeSH Terms: Humans, Antihypertensive Agents, Cardiovascular Diseases, Hypolipidemic Agents, Platelet Aggregation Inhibitors, Assessment of Medication Adherence