Predictors of adherence to composite therapy after acute coronary syndromes

Abstract

Aims Adherence to medical therapy following acute coronary syndrome (ACS) affects a patient's prognosis. In this cohort study, we sought to assess the factors that could affect a patient's adherence to therapy after ACS. Methods We prospectively collected information from patients (N = 964) hospitalized at the coronary care unit of the Federico II University Hospital, from 1 January 2015 to 30 June 2017, for ACS. Adherence to three classes of drugs including statins, antiplatelets [dual or single antiplatelet agent (SAPT)] and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB) and their composites were assessed at 1 month, 1 and 2 years after discharge. Results At 30 days adherence to prescribed therapy was 94.4% for dual antiplatelet therapy (DAPT), 78.2% for statins, 92.7% for ACE-I/ARB and 70.7% for multitherapy. At 1 year, it was 91.1% for DAPT, 81.2% for ACE-I/ARB, 84.9% for statins and 71.4% for multitherapy. At 2 years, it was 97.1% for SAPT, 78.1% for ACE-I/ARB, 91.8% for statins, 72.8% for multitherapy. Multivariable logistic analysis demonstrated that at each time point, a telephone follow-up assessment predicts nonadherence to multitherapy and that a percutaneous coronary intervention at the index hospitalization is an independent predictor of adherence to composite therapy at 1 month and 1 year. Conclusion Up to 2 years after ACS, three out of four patients are adherent to multitherapy prescription; percutaneous coronary intervention during the index hospitalization improves a patient's adherence, whereas telephone follow-up is associated with reduced adherence to multitherapy. Campania Salute Network Registry (Clinical Trials.gov Identifier: NCT02211365).

Coronary artery disease: novel insights in a long-standing disease

“…A quarter of patients were nonadherent to these drugs up to 2 years after hospitalization for ACS. 37 Sacubitril/valsartan was not associated with a lower incidence of death from cardiovascular causes or incident heart failure than ramipril among patients with left ventricular ejection fraction 40% or less and/or pulmonary congestion following acute myocardial infarction. 38 However, sacubitril/valsartan seems to be superior to ramipril among highrisk survivors of acute myocardial infarction.…”

“…Stabile et al 37 investigated adherence to three classes of drugs, including statins, antiplatelets and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers following ACS. A quarter of patients were nonadherent to these drugs up to 2 years after hospitalization for ACS 37 . Sacubitril/valsartan was not associated with a lower incidence of death from cardiovascular causes or incident heart failure than ramipril among patients with left ventricular ejection fraction 40% or less and/or pulmonary congestion following acute myocardial infarction 38 .…”

“…Long-term prognosis of patients with CAD is influenced by adherence to evidence-based medical therapy. Stabile et al 37 investigated adherence to three classes of drugs, including statins, antiplatelets and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers following ACS. A quarter of patients were nonadherent to these drugs up to 2 years after hospitalization for ACS 37 .…”