Evidence for clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications among adults with peripheral artery disease: protocol for a systematic review and meta-analysis

• Published in: BMJ open Vol. 14; no. 3; p. e076795
• Main Authors: de Launay, David, Paquet, Maude, Kirkham, Aidan M, Graham, Ian D, Fergusson, Dean A, Nagpal, Sudhir K, Shorr, Risa, Grimshaw, Jeremy M, Roberts, Derek J
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 21-03-2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Protocol
• Subjects: Amputation; Antihypertensives; Asymptomatic; Beta blockers; Cardiology; Cardiovascular disease; Cardiovascular Medicine; Clinical medicine; Clinical practice guidelines; Diuretics; Emergency medical care; Gender equity; Hypertension; Ischemia; Medical prognosis; Meta-analysis; Mortality; Patient compliance; Patients; Risk Factors; Statins; Systematic Review; Vascular medicine; Vascular surgery; Vein & artery diseases; VASCULAR MEDICINE; Risk Factors; Systematic Review; VASCULAR SURGERY
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-076795

IntroductionInternational guidelines recommend that adults with peripheral artery disease (PAD) be prescribed antiplatelet, statin and antihypertensive medications. However, it is unclear how often people with PAD are underprescribed these drugs, which characteristics predict clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications, and whether underprescription and non-adherence are associated with adverse health and health system outcomes.Methods and analysisWe will search MEDLINE, EMBASE and Evidence-Based Medicine Reviews from 2006 onwards. Two investigators will independently review abstracts and full-text studies. We will include studies that enrolled adults and reported the incidence and/or prevalence of clinician underprescription of or patient non-adherence to guideline-recommended cardiovascular medications among people with PAD; adjusted risk factors for underprescription of/non-adherence to these medications; and adjusted associations between underprescription/non-adherence to these medications and outcomes. Outcomes will include mortality, major adverse cardiac and limb events (including revascularisation procedures and amputations), other reported morbidities, healthcare resource use and costs. Two investigators will independently extract data and evaluate study risk of bias. We will calculate summary estimates of the incidence and prevalence of clinician underprescription/patient non-adherence across studies. We will also conduct subgroup meta-analyses and meta-regression to determine if estimates vary by country, characteristics of the patients and treating clinicians, population-based versus non-population-based design, and study risks of bias. Finally, we will calculate pooled adjusted risk factors for underprescription/non-adherence and adjusted associations between underprescription/non-adherence and outcomes. We will use Grading of Recommendations, Assessment, Development and Evaluation to determine estimate certainty.Ethics and disseminationEthics approval is not required as we are studying published data. This systematic review will synthesise existing evidence regarding clinician underprescription of and patient non-adherence to guideline-recommended cardiovascular medications in adults with PAD. Results will be used to identify evidence-care gaps and inform where interventions may be required to improve clinician prescribing and patient adherence to prescribed medications.PROSPERO registration numberCRD42022362801.