Blog | Wednesday, November 20, 2013

QD: News Every Day--Better medical adherence may not translate to acute coronary syndrome outcomes

A 4-part intervention for acute coronary syndrome improved medication adherence but not clinical outcomes in the first year after a hospitalization among patients, a study found.

253 patients from 4 VA medical centers across the U.S. who were admitted with acute coronary syndrome were randomized to the intervention group or usual care before discharge. The 4-part intervention lasted for 1 year and involved pharmacist-led medication reconciliation; patient education; collaborative care between the pharmacist and a primary care clinician and/or cardiologist (The clinician was told of the intervention, and cosigned the pharmacists’ notes in the computerized medical record); and voice messages reminding patients of educational lessons and medication refill reminders.

Researchers assessed medication adherence, defined as mean proportion of days covered greater than 0.80 in the year following discharge for clopidogrel, β-blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers [ACEI/ARB]). Results appeared online Nov. 18 in JAMA Internal Medicine.

241 patients (95.3%) completed the study, 122 in the intervention group and 119 in the usual care group. 89.3% of patients in the intervention group were adherent, compared with 73.9% in the usual care group (P=0.003). Mean adherence was higher in the intervention group (0.94 vs 0.87; P<0.001). More patients in the intervention group were adherent to clopidogrel (86.8% vs 70.7%; P=0.03), statins (93.2% vs 71.3%; P<0.001), and ACEI/ARB (93.1% vs 81.7%; P=0.03), but not β-blockers (88.1% vs 84.8%; P=0.59).

Despite the better medication adherence, there were no statistically significant differences for patients who achieved blood pressure (P=0.23) and LDL cholesterol targets (P=0.14). There was a non-statistically-significant trend toward greater blood pressure control (58.6% vs 48.9%), decline in systolic blood pressure (−12 vs −4 mm Hg), and decline in diastolic blood pressure (−5 vs −3 mm Hg) for intervention patients. And, there were no statistically significant differences between the 2 groups for rehospitalization for myocardial infarction, revascularization or death. Researchers noted that more research is needed into understanding how medication adherence translates into better clinical outcomes before expanding the program.