Figure 1
Flowchart for studies included according to PRISMA criteria.
Table 1
Summary of the included studies.
| AUTHORS/ SETTING/ COUNTRY | SAMPLES | METHODS | ADHERENCE MEASURE | DURATION OF DISEASE | AVERAGE AGE (YEARS) | LEVEL OF EDUCATION | NON-ADHERENCE % | CCAT % |
|---|---|---|---|---|---|---|---|---|
| Jarrah et al. 2023 (35) Outpatient clinic Jordan | 164 | Cross-sectional study | General Medication Adherence Scale (GMAS) | Not indicated | 62.5 ± 8.8 | The majority (53%) are less than or equal to high school | 47.00% | 83% |
| Jarab et al. 2023 (34) Outpatient clinic Jordan | 427 | Cross-sectional study | Morisky (MMAS-4) | 6.41 ± 6.16 | 63 ± 12 | The majority (69.4%) are not complete their educational pursuits | 92.50% | 80% |
| Shojaee et al. 2023 (42) Outpatient clinic Iran | 474 | Cross-sectional study | Modanloo questionnaire | 62.4% less 6 years HF | 52.86 ± 15.20 | 0% illiterate, and 44.5% upper diploma | 49.30% | 80% |
| Moaddab et al. 2023 (37) NI Iran | 115 | Cross-sectional study | Medication adherence report scale (MARS-5) | Not indicated | 64.01 ± 11.46 | 53.91% illiterate | Not indicated | 78% |
| Sadeghiazar et al. 2022 (40) Hospitalized patient Iran | 237 | Cross-sectional study | The Medication Adherence Report Scale (MARS-10) | Majority 63% less than 9 years | 64.81 ± 14.00 | 49.45% illiterate | 76.90% | 80% |
| Amininasab et al. 2018 (32) Hospitalized patient Iran | 300 | Cross-sectional study | Morisky (MMAS-8) | Not indicated | 64.15 ± 11.47 | 31.8% illiterate | 60.30% | 75% |
| Rezaei et al. 2022 (39) Outpatient clinic Iran | 250 | Cross-sectional study | Morisky (MMAS-8) | Majority (71.8%) less than 10 years | The majority (76%) aged 41–80 years | 0% illiterate, and (57.6%) diploma and upper | 61% | 75% |
| Shamsi et al. 2020 (41) Outpatient clinic Iran | 150 | Cross-sectional study | Morisky (MMAS-8) | Not indicated | 48.48 ± 12.25 | The majority (57.33%) are basic to high school | 23.33% | 70% |
| Lin et al. 2020 (36) Outpatient clinic Iran | 468 | A longitudinal study using cross-sectional design | Medication adherence report scale (MARS-5) | 5.5 ± 3.6 | 69.3 ± 7.3 | Mean 6.8 ± 2.9 yrs | Not indicated | 90% |
| Amininasab et al. 2017 (33) Hospitalized patient Iran | 300 | Cross-sectional study | Morisky (MMAS-8) | Not indicated | 64.15 ± 11.47 | 50.3% illiterate | Not indicated | 63% |
| Raffaa et al. 2020 (38) Outpatient clinic Saudi Arabia | 151 | Cross-sectional study | Morisky (MMAS-4) | 47% less than 3 years | The majority (66.2%) aged above 60 years | 37.7% illiterate | 53.60% | 55% |
| Al-Zaazaai et al. 2019 [31] Hospitalized patient Yemen | 86 | Cross-sectional study | Morisky (MMAS-4) | Not indicated | 56.9 ± 16.0 | 53% illiterate | 56.00% | 55% |
[i] Abbreviations: CCAT: Crowe Critical Appraisal Tool; HF: heart failure; NI: not indicated.
Table 2
Influences on medication adherence.
| POSITIVE EFFECT ON ADHERENCE | NEGATIVE EFFECT ON ADHERENCE | NEUTRAL EFFECT ON ADHERENCE | |
|---|---|---|---|
| Patient-related factors | |||
| Age | n = 1 Jordan Younger than 60 years (35) | n = 1 Iran Aged 54 years and above (42) | n = 8 Iran (32, 36, 39, 40, 41) Yemen (31) Saudi Arabia (38) Jordan (34) |
| Gender | n = 2 Iran Female (39, 40) | n = 8 Iran (32, 36, 37, 41, 42) Yemen (31) Saudi Arabia (38) Jordan (35) | |
| Marital status | n = 2 Saudi Arabia Married (38) Jordan Married (35) | n = 1 Jordan Living alone (35)* | n = 3 Iran (40, 42) Jordan (34) |
| BMI | n = 5 Iran (36, 40, 42) Jordan (34, 35) | ||
| Smoking status | n = 1 Yemen Smoking (31) | n = 6 Iran (36, 39, 42) Saudi Arabia (38) Jordan (34, 35) | |
| Physical activity | n = 3 Iran (39) Saudi Arabia (38) Jordan (34) | ||
| Family history | n = 1 Jordan (34) | ||
| Temperament factors | n = 1 Iran cyclothymic, anxious, hyperthymic, irritable, and depressive temperament (41) | ||
| Housing | n = 1 Saudi Arabia Urban residence (38) | n = 3 Iran (32, 42) Jordan Residential circumstances (34) | |
| Alcohol usage | n = 1 Iran (39) | ||
| Number of children | n = 1 Iran Less than 5 children (32)* | ||
| Khat chewing habit | n = 1 Yemen Khat use (31) | ||
| Diet control | n = 1 Saudi Arabia No diet control (38)* | ||
| Biomedical test | n = 2 Jordan (34) Iran Blood pressure and heart rate (36) | ||
| Condition-related factors | |||
| Duration of HF | n = 2 Saudi Arabia Newly Diagnosed (38) Iran Diagnosed < 5 years (39) | n = 1 Iran Over six years with HF (42) | n = 2 Jordan (34) Iran (36) |
| Comorbidities | n = 1 Iran Mitral valve regurgitation (42) | n = 1 Jordan Diabetes Mellitus (35)* | n = 4 Saudi Arabia (38) Jordan (34, 35) Iran (40) |
| NYHA classification | n = 1 Iran Class 1 (42) | n = 1 Iran Higher NYHA class (40) | n = 2 Jordan (34) Iran (36) |
| Ejection fraction | n = 1 Iran 50–60% (42) | n = 1 Iran 30–40% (34)* | n = 3 Jordan (34, 35) Iran (40) |
| Number of hospitalizations | n = 1 Jordan Ever been hospitalized for HF (35) | n = 1 Iran (32) | |
| Number of other chronic diseases | n = 1 Jordan (34) | ||
| Coronary artery bypass graft surgery | n = 1 Iran History of CABG (40) | ||
| Psychiatric conditions | n = 5 Iran Psychological distress (33, 36) Depression (41) Insomnia (36) Lack of peace of mind, dependency and existential distress (33) | ||
| Cognitive function | n = 1 Iran Mini Mental State (36) | ||
| Sleep disorders | n = 2 Jordan Difficulty of sleeping (35)* Iran Insomnia (36) | ||
| Socioeconomic factors | |||
| Income level | n = 3 Saudi Arabia High income (38) Jordan low income (35)* Iran low Income (40) | n = 2 Iran (32) Jordan (34) | |
| Education level | n = 3 Iran Post-secondary education (32, 42) Jordan Post-secondary education (35) | n = 4 Yemen Illiterate (31) Saudi Arabia High education level (38) Jordan Lower levels of education (34) Iran Lower levels of education (40) | n = 2 Iran (36, 39) |
| Employment status | n = 1 Saudi Arabia Employed (38)* | n = 3 Iran (32, 40) Jordan (34) | |
| Insurance | n = 1 Jordan Insured (35) | n = 1 Yemen Uninsured (31) | n = 1 Iran (42) |
| Health literacy | n = 1 Iran eHealth literacy (36) | n = 1 Iran Insufficient health literacy (39) | |
| Social media | n = 1 Iran Familiar with social media (42) | ||
| Medication factors | |||
| Treatment duration | n = 1 Saudi Arabia long treatment period (38) | ||
| Adverse drug reactions | n = 1 Jordan Side effects (34) | ||
| Number of medications | n = 2 Iran Consuming less than five tablets daily (32)* Jordan Prescribed ACEIs/ARBs and statin therapy (34) | n = 1 Jordan On anticoagulant medication regimen (34) | n = 5 Iran Medication type or number of Medication (36, 39, 40) Saudi Arabia Daily medication intake (38) Jordan Medication count, dosage intervals, satisfaction with treatment, varieties of HF pharmaceuticals, and additional medicinal treatments (34) |
| Institutional factors | |||
| Caregiver support | n = 1 Jordan (35) | ||
| HF control health education | n = 1 Iran Awareness of HF (42) | n = 2 Saudi Arabia Receiving education (38) Saudi Arabia Received Pharmaceutical health education (38) | |
| Distance to Hospital | n = 1 Saudi Arabia Hospital distance exceeding 30 minutes (38) | ||
[i] Abbreviations: NYHA: New York Heart Association; HF: heart failure; CABG: coronary artery bypass grafting; ACEIs: angiotensin-converting enzyme inhibitors; ARBs: Angiotensin II receptor blockers.
Table 3
Quality assessment of the included studies.
| AUTHORS | PRELIMINARIES | INTRODUCTION | DESIGN | SAMPLING | DATA COLLECTION | ETHICAL MATTERS | RESULTS | DISCUSSION | % | STUDY QUALITY |
|---|---|---|---|---|---|---|---|---|---|---|
| Lin et al. (2020) (36) | 5 | 5 | 5 | 4 | 5 | 3 | 4 | 5 | 90% | High |
| Jarrah et al. (2023) (35) | 5 | 5 | 4 | 5 | 3 | 4 | 3 | 4 | 83% | Moderate |
| Shojaee et al. (2023) (42) | 4 | 5 | 4 | 4 | 4 | 3 | 5 | 5 | 80% | Moderate |
| Sadeghiazar et al. (2022) (40) | 5 | 5 | 4 | 4 | 3 | 3 | 3 | 4 | 80% | Moderate |
| Jarab et al. (2023) (34) | 4 | 5 | 4 | 4 | 4 | 3 | 4 | 4 | 80% | Moderate |
| Moaddab et al. (2023) (37) | 3 | 5 | 4 | 3 | 4 | 4 | 3 | 5 | 78% | Moderate |
| Rezaei et al. (2022) (39) | 4 | 5 | 4 | 4 | 3 | 2 | 3 | 5 | 75% | Low |
| Amininasab et al. (2018) (32) | 4 | 4 | 4 | 3 | 3 | 4 | 3 | 5 | 75% | Low |
| Shamsi et al. (2020) (41) | 4 | 4 | 3 | 3 | 3 | 3 | 4 | 4 | 70% | Low |
| Raffaa et al. (2020) (38) | 4 | 4 | 3 | 1 | 2 | 2 | 3 | 3 | 55% | Low |
| Amininasab et al. (2017) (33) | 3 | 4 | 3 | 3 | 3 | 4 | 2 | 3 | 63% | Low |
| Al-Zaazaai et al. 2019 (31) | 3 | 4 | 2 | 2 | 3 | 2 | 3 | 3 | 55% | Low |