Patient-Centered Adherence Intervention After Acute Coronary Syndrome Hospitalization

Lambert-Kerzner, Anne; Giacco, Eric J. Del; Fahdi, Ibrahim E.; Bryson, Chris L.; Melnyk, S. Dee; Bosworth, Hayden B.; Davis, Ryan; Mun, Howard; Weaver, Jennifer; Barnett, Casey; Radcliff, Tiffany A.; Hubbard, Amanda; Bosket, Kevin D.; Carey, Evan; Virchow, Allison; Mihalko-Corbitt, Renee; Kaufman, Amy; Marchant-Miros, Kathy; Ho, P. Michael

doi:10.1161/circoutcomes.111.962290

Cited by 26 publications

(20 citation statements)

References 26 publications

(24 reference statements)

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“…The design of the randomized trial has been described in detail previously 10. In brief, this multicenter, prospective clinical trial enrolled veterans at one of four Veterans Affairs (VA) medical centers with ACS as the primary reason for hospital admission.…”

Section: Methodsmentioning

confidence: 99%

Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study

Marzec¹,

Carey²,

Lambert-Kerzner³

et al. 2015

PPA

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BackgroundPatient nonadherence to cardiac medications following acute coronary syndrome (ACS) is associated with increased risk of recurrent events. However, the prevalence of cognitive dysfunction and poor health literacy among ACS patients and their association with medication nonadherence are poorly understood.MethodsWe assessed rates of cognitive dysfunction and poor health literacy among participants of a clinical trial that tested the effectiveness of an intervention to improve medication adherence in patients hospitalized with ACS. Of 254 patients, 249 completed the Rapid Estimate of Adult Literacy in Medicine, Revised (REALM-R) survey, an assessment of risk for poor literacy, and the St Louis University Mental Status (SLUMS) exam, a tool assessing for neurocognitive deficits, during ACS hospitalization. We assessed if SLUMS or REALM-R scores were associated with medication adherence.ResultsBased on SLUMS score, 14% of patients were categorized as having dementia, and 52% with mild neurocognitive disorder (MNCD). Based on REALM-R score of ≤6, 34% of patients were categorized as at risk for poor health literacy. There was no association between poor health literacy and medication nonadherence. Of those with MNCD, 35.5% were nonadherent, compared to 17.5% with normal cognitive function and 6.7% with dementia. In multivariable analysis, cognitive dysfunction was associated with medication nonadherence (P=0.007), mainly due to an association between MNCD and nonadherence (odds ratio =12.2, 95% confidence interval =1.9 to 243; P=0.007). Cognitive status was not associated with adherence in patients randomized to the intervention.ConclusionCognitive dysfunction and risk for poor health literacy are common in patients hospitalized with ACS. We found an association between MNCD and medication nonadherence in the usual care group but not in the intervention group. These findings suggest efforts to screen for MNCD are needed during ACS hospitalization to identify patients at risk for nonadherence and who may benefit from an adherence intervention.

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Section: Methodsmentioning

confidence: 99%

Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study

Marzec¹,

Carey²,

Lambert-Kerzner³

et al. 2015

PPA

Self Cite

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“…These strategies include: promotion of healthier life styles, hospital-initiated transitional care [53, 54], and post-hospitalization support, such as follow-up for disadvantaged patients [55] and patient-centred adherence intervention [56]. These strategies are not mutually exclusive and their effectiveness finds support in the literature.…”

Section: Discussionmentioning

confidence: 99%

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy

Cafagna

Seghieri

2017

BMC Health Serv Res

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BackgroundThere is a growing interest in the factors that influence short-term mortality and readmission after hospitalization for acute myocardial infarction (AMI) since such outcomes are commonly considered as hospital performance measures. Socioeconomic status (SES) is one of the factors contributing to healthcare outcomes after hospitalization for AMI. However, no study has been published on education and 30-day readmission in Europe. The objective of this study is to examine the association between educational level and 30-day mortality and readmission among patients hospitalized for AMI in Tuscany (Italy).MethodsA retrospective cohort study using data from hospital discharge records was conducted. The analysis included all patients discharged with a principal diagnosis of AMI between January 1, 2011, and November 30, 2014, from all hospitals in Tuscany. Educational level was categorized as low (no middle school diploma), mid (middle school diploma) and high (high school diploma or more). Three multilevel models were developed, sequentially controlling for patient-level socio-demographic and clinical variables and hospital-level variables. Patients were stratified by age (≤75 and >75 years).ResultsMortality analysis included 23,402 patients, readmission analysis included 22,181 patients. In both unadjusted and full-adjusted models, patients with a high education had lower odds of 30-day mortality compared to those patients with low education (OR age ≤ 75 years 0.67, 95% CI:0.47–0.94; OR age > 75 years 0.72, 95% CI:0.54–0.95). With regard to 30-day readmission, only patients aged over 75 years with a high education had lower odds of short-term readmission compared to those patients with low education (OR age > 75 0.73, 95% CI:0.58–0.93).ConclusionsAmong patients hospitalized in Tuscany for AMI, low levels of education were associated with increased odds of 30-day mortality for both age groups and increased odds of 30-day readmission only for patients aged over 75 years. Our findings suggest that the educational component should not be underestimated in order to improve short-term outcomes, which are considered as performance measures at the hospital level. Hospital managers might consider strategies that are sensitive to patients with low SES, such as providing post-hospitalization support to less-educated patients and promoting a healthier lifestyle, to improve both health equity and performance outcomes.

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“…Current methods of improving medication adherence for chronic health problems are mostly complex and not very effective, so the full benefits of treatment cannot be realized 26. However, earlier studies in ACS patients have shown that multifaceted patient-centered interventions could improve adherence to cardioprotective medications; in particular, respectful collaborative communication can contribute to medication adherence after ACS hospitalization 27,28…”

Section: Discussionmentioning

confidence: 99%

High adherence to therapy and low cardiac mortality and morbidity in patients after acute coronary syndrome systematically managed by office-based cardiologists in Germany: 1-year outcomes of the ProAcor Study

Goss¹,

Brachmann

Hamm

et al. 2017

VHRM

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We aimed to assess patient acceptance and effectiveness of a 12-month structured management program in patients after an acute coronary syndrome (ACS) event who were treated in a special setting of office-based cardiologists. The program comprised patient documentation with a specific tool (Bundesverband Niedergelassener Kardiologen [German Federation of Office-Based Cardiologists] cardiac pass with visit scheduling) shared by the hospital physician and the office-based cardiologist, the definition of individual treatment targets, and the systematic information of patients in order to optimize adherence to therapy. Participating centers (36 hospitals, 60 office-based cardiologists) included a total of 1,003 patients with ACS (ST-segment elevation myocardial infarction [STEMI] 44.3%, non-ST-segment elevation myocardial infarction [NSTEMI] 39.5%, unstable angina pectoris [UA] 15.2%, and unspecified 1.0%). During follow-up, treatment rates with cardiac medication remained high in all groups, with dual antiplatelet therapy in 91.0% at 3 months, 90.0% at 6 months, and 82.8% at 12 months, respectively. Twelve months after the inclusion, a total of 798 patients (79.6%) still participated in the program. Eighteen patients (1.8%) had died after discharge from hospital (6 in the STEMI, 12 in the NSTEMI group), while for 58 the status was unknown (5.8%). Based on a conservative approach that considered patients with unknown status as dead, 1-year mortality was 7.6%. Recurrent cardiac events were noted in 14.9% at 1 year, with an about equal distribution across STEMI and NSTEMI patients. In conclusion, patients’ acceptance of the ProAcor program as determined by adherence rates over time was high. Treatment rates of recommended medications used for patients with coronary heart disease were excellent. The 1-year mortality rate was comparatively low.

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Patient-Centered Adherence Intervention After Acute Coronary Syndrome Hospitalization

Cited by 26 publications

References 26 publications

Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study

Cognitive dysfunction and poor health literacy are common in veterans presenting with acute coronary syndrome: insights from the MEDICATION study

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy

High adherence to therapy and low cardiac mortality and morbidity in patients after acute coronary syndrome systematically managed by office-based cardiologists in Germany: 1-year outcomes of the ProAcor Study

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