Adherence to pharmacotherapy for secondary prevention of coronary heart disease: A registry-based prospective study

Abstract

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 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.

Keywords

• Acute coronary syndrome
• Adherence
• Antiplatelets
• Statins
• Secondary prevention