ArticleEClinicalMedicine2025
Clinician underprescription of and patient nonadherence to clinical practice guideline-recommended medications for peripheral artery disease: a systematic review and meta-analysis.
Article in EClinicalMedicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Guidelines recommend that adults with peripheral artery disease (PAD) take antiplatelets, statins, and antihypertensives. However, it is unclear how frequently clinicians do not prescribe these medications (ie, underprescription), how often patients fail to fill/refill their prescriptions (ie, nonadherence), which factors increase underprescription/nonadherence risk, and whether underprescription/nonadherence are associated with outcomes. Methods: We searched MEDLINE, EMBASE, CENTRAL, and Evidence-Based Medicine Reviews (January 1, 2006-to-February 18th, 2025) for studies reporting cumulative incidences/point prevalences of clinician underprescription and/or patient nonadherence to antiplatelets, statins, and/or antihypertensives; adjusted-risk factors for underprescription/nonadherence; and adjusted-outcomes associated with underprescription/nonadherence among adults with PAD. Two investigators independently screened citations, extracted data, and assessed risk of bias. Data were pooled using random-effects models. Estimate certainty was communicated using GRADE. The study was registered on PROSPERO (CRD42022362801). Findings: Among 4206 citations identified, 125 studies (n = 14,681,801 participants; 37% female) were included. The pooled cumulative incidence of antiplatelet, statin, and antihypertensive (among those with PAD and hypertension) underprescription was 28% (95% confidence interval [CI] = 21-36%; moderate-certainty), 34% (95% CI = 31-38%; high-certainty), and 43% (95% CI = 33-53%; moderate-certainty), respectively. The cumulative incidence of antiplatelet, statin, and antihypertensive nonadherence was 27% (95% CI = 20-35%; moderate-certainty), 28% (95% CI = 24-33%; high-certainty), and 23% (95% CI = 22-24%; low-certainty), respectively. Underprescription was more common in population-based studies and those enrolling more females and past/current smokers while nonadherence was more common in studies enrolling more patients with diabetes. Underprescription risk factors included female sex, advanced age, malignancy history, and chronic limb-threatening ischemia (all moderate-certainty). Nonadherence risk factors included advanced age, comorbidity burden, and receiving specialist mental health care (all moderate-certainty). Underprescription was associated with increased major adverse cardiac events, all-cause mortality, and decreased amputation-free time (all moderate-certainty). Interpretation: One-quarter-to-one-half of adults with PAD are not prescribed antiplatelets, statins, and antihypertensives. Further, approximately one-quarter of these patients do not adhere to these medications after prescription. Funding: This research was supported by a 2024 Vanier Canada Graduate Scholarship (awarded to AMK and supervised by DJR), a Graham Farquharson Physician Services Incorporated Knowledge Translation Fellowship (awarded to DJR), and a Research Program Award, University of OttawaDepartment of Surgery Annual Competition (awarded to DJR).
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.