Hellenic Journal of Cardiology (Jul 2019)

Motivational interviewing to support LDL-C therapeutic goals and lipid-lowering therapy compliance in patients with acute coronary syndromes (IDEAL-LDL) study: rationale and design

  • Aristi Boulmpou,
  • Anastasios Kartas,
  • Ioannis Farmakis,
  • Stefanos Zafeiropoulos,
  • Vasileios Nevras,
  • Ioannis Papadimitriou,
  • Athina Tampaki,
  • Anastasia Vlachou,
  • Leonidas Lillis,
  • Athanasios Koutsakis,
  • Haralampos Karvounis,
  • George Giannakoulas

Journal volume & issue
Vol. 60, no. 4
pp. 249 – 253

Abstract

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Background: Achieving low-density lipoprotein cholesterol (LDL-C) target levels after an acute coronary syndrome (ACS) is of paramount importance, and is often burdened by undertreatment and medication or lifestyle non-adherence issues. Objective: We examined the effect of a patient-centered, physician-led motivational intervention following ACS on relevant secondary prevention aspects. Methods-design: The IDEAL-LDL is a single-center, randomized controlled clinical trial, conducted among patients hospitalized due to an ACS. Following discharge, all patients undergo a baseline assessment of lipid profile. Patients in the intervention group receive an in-person educational session and an informative leaflet, and also undergo two phone-based, motivational interviewing sessions at 1 and 6 months. These interventions emphasize on LDL-C goals, adherence to lipid-lowering medication, and healthy dietary-lifestyle habits, and are not provided to patients in the control group, who receive usual care. At 12 months after each patient's discharge, an in-person interview and lipid profile reassessment are performed. The primary outcomes are the assessment of LDL-C goal achievement (50% reduction from baseline levels) from baseline to 1 year and changes in medication adherence. Secondary outcomes relate to the incidence of the composite outcome of cardiovascular death, nonfatal myocardial infarction/stroke, need for myocardial revascularization, and recurrent hospitalization during the follow-up period. Discussion: This paper describes the protocol, design, and rationale for key methodology for an ongoing clinical trial featuring a simple and feasible intervention. Similar adherence efficacy trials have not led to sufficient improvements, and there remains a gap regarding how adherence interventions should be implemented into clinical care. Keywords: Acute coronary syndrome, Dyslipidemia, Statin therapy, Medication adherence, Lifestyle modification