<?xml version="1.0" encoding="UTF-8"?><xml><records><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Bowry, A. D.</style></author><author><style face="normal" font="default" size="100%">Shrank, W. H.</style></author><author><style face="normal" font="default" size="100%">Lee, J. L.</style></author><author><style face="normal" font="default" size="100%">Stedman, M.</style></author><author><style face="normal" font="default" size="100%">Choudhry, N. K.</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">A systematic review of adherence to cardiovascular medications in resource-limited settings</style></title><secondary-title><style face="normal" font="default" size="100%">J Gen Intern Med</style></secondary-title></titles><dates><year><style  face="normal" font="default" size="100%">2011</style></year><pub-dates><date><style  face="normal" font="default" size="100%">Aug 20</style></date></pub-dates></dates><urls><web-urls><url><style face="normal" font="default" size="100%">http://www.ncbi.nlm.nih.gov/pubmed/21858602</style></url></web-urls></urls><edition><style face="normal" font="default" size="100%">2011/08/23</style></edition><volume><style face="normal" font="default" size="100%">26</style></volume><pages><style face="normal" font="default" size="100%">1479-91</style></pages><isbn><style face="normal" font="default" size="100%">1525-1497 (Electronic)0884-8734 (Linking)</style></isbn><language><style face="normal" font="default" size="100%">Eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;BACKGROUND: Medications are a cornerstone of the prevention and management of cardiovascular disease. Long-term medication adherence has been the subject of increasing attention in the developed world but has received little attention in resource-limited settings, where the burden of disease is particularly high and growing rapidly. To evaluate prevalence and predictors of non-adherence to cardiovascular medications in this context, we systematically reviewed the peer-reviewed literature. METHODS: We performed an electronic search of Ovid Medline, Embase and International Pharmaceutical Abstracts from 1966 to August 2010 for studies that measured adherence to cardiovascular medications in the developing world. A DerSimonian-Laird random effects method was used to pool the adherence estimates across studies. Between-study heterogeneity was estimated with an I(2) statistic and studies were stratified by disease group and the method by which adherence was assessed. Predictors of non-adherence were also examined. FINDINGS: Our search identified 2,353 abstracts, of which 76 studies met our inclusion criteria. Overall adherence was 57.5% (95% confidence interval [CI] 52.3% to 62.7%; I(2) 0.98) and was consistent across study subgroups. Studies that assessed adherence with pill counts reported higher levels of adherence (62.1%, 95% CI 49.7% to 73.8%; I(2) 0.83) than those using self-report (54.6%, 95% CI 47.7% to 61.5%; I(2) 0.93). Adherence did not vary by geographic region, urban vs. rural settings, or the complexity of a patient's medication regimen. The most common predictors of poor adherence included poor knowledge, negative perceptions about medication, side effects and high medication costs. INTERPRETATION: Our study indicates that adherence to cardiovascular medication in resource-limited countries is sub-optimal and appears very similar to that observed in resource-rich countries. Efforts to improve adherence in resource-limited settings should be a priority given the burden of heart disease in this context, the central role of medications in their management, and the clinical and economic consequences of non-adherence.&lt;/p&gt;
</style></abstract><accession-num><style face="normal" font="default" size="100%">21858602</style></accession-num><notes><style face="normal" font="default" size="100%">&lt;p&gt;Journal articleJournal of general internal medicineJ Gen Intern Med. 2011 Aug 20.&lt;/p&gt;
</style></notes><auth-address><style face="normal" font="default" size="100%">Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA.</style></auth-address></record></records></xml>