CURRENT ISSUE

ABSTRACT: Background: Cardiovascular disease remains a leading cause of global morbidity and mortality, and long-term secondary prevention is often limited by poor adherence, pill burden, treatment costs, and health system barriers. Fixed-dose combination polypills may simplify treatment by combining multiple cardiovascular medicines into a single formulation, thereby improving adherence and reducing recurrent cardiovascular events.
Objective: This systematic review evaluated the cost-effectiveness of fixed-dose combination polypills compared with usual care, standard therapy, or separate monocomponents for secondary cardiovascular disease prevention across different healthcare and income settings.
Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Dimensions AI, ScienceDirect, and the Tufts Cost-Effectiveness Analysis Registry were searched for studies published between January 2015 and December 2025. Eligible studies included economic evaluations involving adults with established cardiovascular disease and reporting incremental cost-effectiveness ratios, cost per quality-adjusted life year, cost per disability-adjusted life year, cost savings, or related economic outcomes. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist.
Results: Fourteen records were included, comprising 13 full or partial economic evaluations and one Delphi consensus study with policy-relevant contextual interpretation. Most studies were conducted in high-income countries, particularly Spain, while evidence from low- and middle-income countries was limited. Fixed-dose combination polypills were generally reported as cost-effective or cost-saving, mainly driven by improved medication adherence, reduced pill burden, and prevention of recurrent cardiovascular events. Findings were also influenced by methodological factors such as analytic perspective and time horizon adopted across studies.
Conclusion: Fixed-dose combination polypills may offer economic value for secondary cardiovascular disease prevention, but broader implementation should be guided by local cost-effectiveness, affordability, budget impact, and real-world evidence, especially in low- and middle-income countries.

ABSTRACT: Introduction: Heart failure is a chronic condition that can negatively affect patients’ self-efficacy and lead to disease-related complications. Limited health literacy may hinder patients’ ability to effectively manage their condition and maintain self-efficacy. This study aimed to investigate the association between health literacy and self-efficacy among patients with heart failure.
Methods: This cross-sectional study was conducted among 193 patients with heart failure who were referred to two hospitals in Fars Province, Iran, in 2023. Participants were selected using convenience sampling. Data were collected using the Cardiac Self-Efficacy Questionnaire developed by Sullivan et al. (1998) and a heart failure-specific health literacy scale. Descriptive statistics, Pearson’s correlation coefficient, and multiple linear regression analyses were performed using SPSS version 21.
Results: Overall, 63.7% of participants demonstrated high levels of self-efficacy. Among the dimensions of health literacy, functional health literacy had the highest mean score (8.33 ± 3.67), whereas critical health literacy had the lowest mean score (4.21 ± 3.91). Health literacy was positively associated with self-efficacy (r = 0.27, p < 0.001). Multiple linear regression analysis indicated that age was a significant negative predictor of self-efficacy (β = -0.134, p = 0.001).
Conclusions: Health literacy was significantly associated with self-efficacy among patients with heart failure. Interventions aimed at improving health literacy, particularly critical health literacy skills, may enhance patients’ self-efficacy and support better disease self-management.