Non-adherence with drug treatment after heart or lung transplantation in adults: A systematic review

ObjectiveHeart or lung transplantation is a complex intervention requiring medication adherence. The objective of this systematic review is to estimate the prevalence of non-adherence (NA) with post-transplantation medication in heart or lung recipients and to assess its clinical impact. We examined in the selected studies if the authors considered the patient's perspective in their evaluations.MethodsThe electronic database MEDLINE, EMBASE and The Cochrane Central Register were searched. Only studies that reported the number of non-adhere subjects were eligible. The different methods of measurement, the ways in which authors defined NA and if authors had integrated patient's perspective in their secondary objectives were also assessed.ResultsThe range frequency of NA was 1–42.9% for all drugs. Non-adherent patients tend to experience worse outcomes compared to adherent patients. The patient's perception of drug side-effects is the most reported patient-related factor for impairing adherence.ConclusionNA after heart or lung transplantation is an important issue and concerns not only immunosuppressant treatments. The main striking point of the selected studies is the lack of patient perspective and the omission of patients–healthcare providers’ relationship.Practice implicationsFuture research must focus on patients’ motivation for the medication-taking behaviour.