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Multifaceted Intervention to Improve Medication Adherence and Secondary Prevention Measures After Acute Coronary Syndrome Hospital Discharge: A Randomized Clinical Trial
Study Questions:
What is the effectiveness of a multifaceted intervention to improve adherence to cardioprotective medications in the year after hospital discharge for acute coronary syndrome (ACS)?
Methods:
This was a multisite, randomized clinical trial conducted among 253 patients from four Department of Veterans Affairs medical centers. Eligible patients with an index hospitalization for ACS were randomized to the multifaceted intervention (INT) or usual care (UC) prior to discharge. The 1-year INT included the following: medication reconciliation and tailoring by a pharmacist within 7-10 days of hospital discharge, patient education, collaborative care, and voice messaging at regularly scheduled intervals. The primary outcome was proportion of patients adherent to the following four cardioprotective medications: clopidogrel, beta-blockers, statins, and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers. Medication adherence was calculated based on the proportion of days covered (PDC) during 1-year follow-up. Secondary outcomes were the proportion of patients reaching blood pressure (BP) and low-density lipoprotein (LDL) cholesterol goals.
Results:
In the INT group, 89.3% of patients were adherent compared with 73.9% in the UC group (p = 0.003). There were no statistically significant differences in the proportion of patients reaching BP (p = 0.23) or LDL cholesterol (p = 0.14) targets. The incremental cost of the INT was $360 per patient.
Conclusions:
The authors concluded that a multifaceted intervention increased adherence to cardioprotective regimens in the year after ACS hospital discharge without improving BP and LDL cholesterol targets.
Perspective:
While long-term adherence to cardioprotective regimens following ACS is known to often be poor, there are a paucity of data evaluating interventions that may improve continued adherence. And although the authors report improved medication compliance with a multifaceted intervention, compared to usual care, clinical endpoints were unchanged. Further studies clarify the role of such interventions and fully evaluate (with appropriately long-term follow-up) their impact on meaningful clinical endpoints.
Keywords: Lipoproteins, LDL, Medication Adherence, Acute Coronary Syndrome, Secondary Prevention, Cholesterol, LDL, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medication Reconciliation, Blood Pressure, Patient Discharge, United States
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