Interventions to improve adherence to statins: a summary of current evidence

Statin non-adherence and discontinuation is common and associated with a higher risk of cardiovascular events than adherence and persistence. We aimed to summarise the effectiveness of interventions employed to improve statin adherence and persistence. Data sources included systematic reviews (SR), meta-analyses (MA), randomised controlled trials (RCT) and alternative design studies (e.g. cohort, quasi-experimental, prospective and retrospective) from EMBASE, Medline and PubMed databases, without date restrictions. Studies that evaluated an intervention targeting adherence to self-administered statin medication for primary or secondary prevention were eligible. Adherence, as primary measure, and lipid levels as secondary measure were analysed. Findings were reported by category of intervention and study design. Potential implementation of successful interventions within the UK NHS was assessed, as well as the resources required. Nineteen SR and MAs, forty-three RCTs, and twenty studies of alternative design were included. Interventions were categorized into eight categories. Modification of statin regimen, financial considerations, and blended interventions improved statin adherence compared to usual care. Patient-targeting behavioural interventions were least likely to be successful. Pharmacists were most commonly involved in intervention delivery. All sixty-one interventions were found to be practical, albeit some were dependent on availability of resources required. HCP training was needed for almost 80% of the interventions. A variety of successful interventions to improve adherence to statins have been reported and are easily applicable within the NHS. Investment in staff training is important for successful implementation of these interventions in routine practice.