Improving Adherence to Ticagrelor in Patients After Acute Coronary Syndrome: Results from the PROGRESS Trial
Mario Crisci1, Felice Gragnano2, Marco Di Maio2
1Department of Cardiology, Division of Interventional Cardiology, A.O.R.N. dei Colli - Monaldi Hospital, Naples, Italy.
Insights
Dedicated in-person follow-up significantly reduces dual antiplatelet therapy disruption in acute coronary syndrome patients. This strategy improves adherence to ticagrelor compared to telephone follow-up alone.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor is crucial for acute coronary syndrome (ACS) patients.
- Underuse and premature discontinuation of DAPT are prevalent issues in clinical practice.
- Effective strategies are needed to improve adherence to prescribed DAPT regimens.
Purpose of the Study:
- To evaluate the impact of a dedicated follow-up strategy on ticagrelor adherence in post-ACS patients.
- To compare the effectiveness of in-person clinical visits versus telephone interviews in maintaining DAPT.
- To assess the rate of DAPT disruption and related complications at one year.
Main Methods:
- The PROGRESS trial was a prospective, randomized study involving 400 ACS patients on ticagrelor.
- Patients were randomized to either in-person follow-up (IN-FU) or telephone follow-up (TEL-FU).
- The primary endpoint was the rate of DAPT disruption at 1-year follow-up, categorized by duration.
Main Results:
- Ticagrelor disruption at 1 year was significantly lower in the IN-FU group (5.5%) compared to the TEL-FU group (19.6%).
- The IN-FU group showed significantly reduced rates of short (3.0% vs 8.5%) and permanent (2.0% vs 9.6%) DAPT disruption.
- No significant difference in major bleeding rates was observed between the two follow-up groups.
Conclusions:
- Dedicated in-person clinical follow-up is superior to telephone-only follow-up in reducing DAPT disruption in ACS patients.
- This strategy enhances adherence to ticagrelor, a critical component of post-ACS care.
- In-person follow-up offers a net benefit in maintaining DAPT without increasing bleeding risk.
Background:
Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor is recommended for at least 12 months in patients after an acute coronary syndrome (ACS). However, its underuse and premature discontinuation are common in clinical practice. We aimed to investigate the impact of a dedicated follow-up strategy with clinical visits and counselling on adherence levels to ticagrelor in patients after ACS.
Methods:
PROGRESS (PROmotinG dual antiplatelet therapy adheREnce in the setting of acute coronary Syndromes) is a prospective, randomized trial enrolling 400 ACS patients treated with ticagrelor. Patients were randomized to be followed-up in a dedicated outpatient clinic (In-person follow-up group, [IN-FU], n=200), or with scheduled for phone interviews only (Telephone follow-up group [TEL-FU], n=200), to assess ticagrelor adherence and related complications. DAPT disruption was defined as an interruption of the administration of the drug due to complications or other reasons of non-adherence, and divided according to the duration into short (1-5 days), temporary (6-30 days) and permanent (≥30 days) disruption. The primary endpoint was the rate of DAPT disruption at 1-year follow-up.
Results:
The rate of ticagrelor disruption at 1 year follow-up was higher in the TEL-FU group than in the IN-FU group (19.6 vs 5.5%; p<0.0001). The IN-FU group reported a significantly lower rate of short (3.0 vs 8.5%; p=0.012) and permanent (2.0 vs 9.6%; p=0.012) disruption than TEL-FU group. The rate of major bleeding did not differ significantly between the 2 groups (p=0.450).
Conclusion:
The PROGRESS trial showed a net reduction in DAPT disruption in patients followed-up with clinical (in-person) follow-up visits in a dedicated outpatient clinic compared with those scheduled for phone interviews only.
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