Can mobile apps improve medication adherence, outcomes in CVD patients?

Mobile apps tend to improve medication adherence and health-related outcomes in patients with cardiovascular disease (CVD), but interventions differ substantially in terms of design, content, and delivery, according to the results of a systematic review and meta-analysis.

“Apps have an acceptable degree of usability, [but] app characteristics conferring usability and effectiveness are often indeterminate due to their multifactorial design,” the researchers said.

Randomized controlled trials (RCTs) investigating app-based interventions aimed at improving medication adherence in CVD patients were identified by searching electronic databases (ie, Medline, PubMed Central, Cochrane Library, Cinahl Plus, PsycINFRO, Embase, and Google Scholar). RCTs published in English from inception to January 2020 were included in the review.

The researchers assessed eligible studies using the Cochrane risk of bias tool. They also performed a meta-analysis for clinical outcomes and medication adherence, and meta-regression analysis to examine the impact of app intervention duration on medication adherence.

Sixteen RCTs published within the last 6 years met the eligibility criteria, of which 12 reported medication adherence as the primary outcome. Intervention duration ranged from 1 to 12 months, and sample sizes ranged from 24 to 412. [J Med Internet Res 2021;23:e24190]

Nine RCTs reported statistically significant improvements in medication adherence rates for app interventions when compared with the control. Meta-analysis of six RCTs reporting continuous data also favoured the use of mobile apps with a high statistical heterogeneity (mean difference, 0.90, 95 percent confidence interval, 0.03–1.78; I², 93.32 percent).

Nine RCTs that evaluated clinical outcomes also saw an improvement in systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels in the intervention arm. In a meta-analysis of these outcomes from six RCTs, mobile apps were found to be beneficial but statistically not significant.

Seven RCTs assessing usability found all mobile apps to be acceptable. However, app characteristics varied widely.

In addition, 10 trials involved healthcare professionals (HCPs; ie, physicians and nurses) in the app-based interventions. Functionality differed across apps: two used education, seven delivered reminders, and seven had both reminders and educational support.

“The involvement of any HCP in the administration and concomitant use of apps with patients requires careful consideration,” the researchers said. “Such apps have the potential to increase HCP workload, and it remains unclear whether the cost of that involvement outweighs the benefits observed.”

In a network meta-analysis, technology-based interventions significantly contributed to long-term management of medication adherence in CVD patients. The World Health Organization categorized medication adherence measurements as either subjective or objective. [Front Pharmacol 2018;24;9:1454; https://www.who.int/chp/knowledge/publications/adherence_introduction.pdf?ua=1]

“Healthcare apps have the potential to enhance medication adherence, leading to improvements in clinical and nonclinical outcomes in patients with CVD. However, the use of this technology to support medication adherence is in its infancy, and apps require robust testing to demonstrate its effectiveness,” the researchers said.

“Existing evidence is currently insufficient to unreservedly recommend the use of healthcare apps to improve adherence to CVD medications because of the generally small sample sizes; clinical and methodological heterogeneity between studies; and disparity in app features, content, and delivery, but they may enhance medication adherence as part of a package of care,” they added.