Intervention may improve post-ACS medication adherence

Adherence to medication regimens among patients discharged after acute coronary syndrome (ACS) improved through the use of a multifaceted intervention, a study published in the February issue of JAMA Internal Medicine found. However, blood pressure levels and levels of low-density lipoprotein (LDL) cholesterol did not improve.

Researchers led by P. Michael Ho, MD, PhD, of the Denver VA Medical Center, randomized 253 Veterans Affairs (VA) patients with ACS from four facilities to the multifaceted intervention (INT) or usual care (UC) before discharge. The intervention consisted of four components.

Medication reconciliation and tailoring were done by a pharmacist within about a week of discharge. The pharmacist called participants one month later to assess any adverse effects and address adherence issues.

The second component was patient education. Patients received education about their medications about a week before discharge and followed up with a pharmacist one week later and one month later. After that, they received information via voice messages.

The other components were collaborative care, which consisted of communication between the pharmacist and the primary care physician and/or cardiologist; and voice messaging, which consisted of medication refill calls and medication reminder calls.

The primary outcome was the number of patients who adhered to their medication regimens based on an average proportion of days covered (PDC) greater than 0.8 in the year after discharge using pharmacy refill information for four medications—clopidogrel (Plavix, Bristol-Myers Squibb), beta-blockers, statins and ACEI/ARB. Attainment of blood pressure and LDL cholesterol goals were secondary outcomes.

Of the 241 patients who completed the study, 89.3 percent of INT patients were adherent compared with 73.9 percent in the UC group. The INT group had a higher average PDC (0.94) compared with the UC group (0.87).

Adherence in the INT group was greater for clopidogrel (86.8 percent vs. 70.7 percent), statins (93.2 percent vs. 71.3 percent) and ACEI/ARB (93.1 percent vs. 81.7 percent). However, it was not greater for beta-blockers (88.1 percent vs. 84.8 percent). In terms of attainment of blood pressure and LDL cholesterol goals, there were no significant differences between the two groups.

They estimated the cost of the program as approximately $360 per patient per year.

Ho and colleagues explained that while their findings suggested better adherence with a multifaceted adherence intervention, “[a]dditional studies are needed to understand the impact of the magnitude of adherence improvement shown in our study on clinical outcomes prior to broader dissemination of such an adherence program,” they wrote.