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Adherence to pharmacotherapy for secondary prevention of coronary heart disease: A registry-based prospective study
Aradhai Bana1, Krishna Kumar Sharma2, Soneil Guptha3
1Norwich Medical School, University of East Anglia, Norwich, NR47TJ, UK.
Insights
Medication adherence after acute coronary syndrome (ACS) in India is suboptimal, with significant declines in crucial secondary prevention drugs within six months. Strategies are needed to improve patient adherence to these life-saving therapies.
Area of Science:
- Cardiology
- Pharmacotherapy
- Public Health
Background:
- Limited data exists on secondary prevention medication adherence post-acute coronary syndrome (ACS) in India.
- Understanding adherence patterns is crucial for improving long-term outcomes in ACS patients.
Purpose of the Study:
- To evaluate adherence to recommended secondary prevention medications following ACS hospitalization in India.
- To identify trends in medication use and adherence at six months post-discharge.
Main Methods:
- A registry-based study involving consecutive ACS patients.
- Data collection included demographics, baseline characteristics, in-hospital interventions, and discharge medications (antiplatelets, statins, beta-blockers, ACEI/ARB, CCB).
- Six-month follow-up assessed medication adherence using validated tools.
Main Results:
- High initial prescription rates for aspirin (97.3%), dual antiplatelets (99.7%), and statins (99.7%) at discharge.
- Significant decline in medication use at six months: aspirin (83.9%), dual antiplatelets (70.2%), statins (70.0%), beta-blockers (50.4%), ACEI/ARB (22.4%).
- Overall good adherence (>80%) was observed in only 42.7% of patients; government-sponsored insurance correlated with better adherence.
Conclusions:
- Adherence to secondary prevention pharmacotherapy post-ACS and percutaneous coronary intervention (PCI) is suboptimal at six months.
- A notable decline (16-42%) in the use of various essential medications was observed.
- Development and implementation of strategies to enhance adherence are urgently required.
Background And Objective:
There is limited data on secondary prevention medications following acute coronary syndrome (ACS) in India. We performed a registry-based study to evaluate adherence to recommended medications following ACS hospitalisation.
Methods:
Consecutive patients admitted with ACS were recruited. Data on demographics, baseline characteristics, in-hospital interventions, and prescribed secondary prevention therapies (antiplatelets, statins, beta-blockers, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and calcium channel blockers (CCB) at discharge were recorded. 6-months follow-up was conducted to evaluate adherence using validated tools.
Results:
716 patients were recruited; the mean age was 60.4 ± 11 years, percutaneous coronary angioplasty (PCI) was performed in 714 (99.7 %) and bypass surgery in none. At hospital discharge, the cardioprotective medications were: aspirin 97.3 %, dual antiplatelets 99.7 %, statins 99.7 %, beta-blockers 74.2 %, ACEI/ARB 38.8 % and CCB 10.9 %. Follow-up data were available for 554 patients; 15 (2.1 %) died and 147 (20.5 %) were lost to follow-up. Medication status and change at 6 months was aspirin 83.9 % (-15.9 %); dual antiplatelets 70.2 % (-29.5 %), statins 70.0 % (-29.8 %), beta-blockers 50.4 % (-32.1 %), ACEI/ARB 22.4 % (-42.3 %) and CCB (-36.7 %) (p < 0.05). Use of high-intensity statins declined from 92.0 % to 45.7 % (-50.3 %). At follow-up, good adherence (>80 %) was 42.7 %, low adherence 24.4 % and non-adherence 10.2 %. Patients with government-sponsored insurance had better adherence than privately insured and self-paying.
Conclusions:
Following acute coronary syndrome and PCI, the adherence to prescribed pharmacotherapy is sub-optimal at 6 months with a decline in various medications of 16-42 %. Strategies to increase adherence to secondary prevention therapies are required.
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