THE ADHERENCE TO RECOMMENDED THERAPY IN PATIENTS AFTER ACUTE CORONARY SYNDROME, AND RISK OF CARDIOVASCULAR COMPLICATIONS WITHIN A YEAR AFTER HOSPITAL ADMISSION

Abstract

Aim. In patients after acute coronary syndrome (ACS) to study the effect of adherence to recommended therapy on the risk of cardiovascular events during a year after hospital admission, and to identify the main causes of low adherence to prescribed therapy. Material and methods. Patients with ACS (n=271), consistently admitting to the emergency cardiology department were included into the study. Complex therapy (acetylsalicylic acid (ASA), beta-blockers (BB), ACE inhibitors, statins) was prescribed to all patients. The drugs prescription rate was analyzed. The cardiovascular events (death, myocardial infarction, stroke, episodes of unstable angina, decompensated heart failure) were recorded for 12 months. The adherence of patients to recommended therapy was evaluated. Results. After hospital discharge ASA therapy was recommended to 98% of patients, BB — 95%, ACE inhibitors — 97%, statins — 63%. In 12 months only 73% of patients continued therapy with ASA, 66% — BB, 74% — ACE inhibitors, 44% — statins. The rate of hospital re-admission was significantly higher in patients with low adherence: 80% (n=32) vs 24% (n=55) among compliant patients. The main causes of hospital re-admission were decompensated heart failure (46%), recurrent episodes of angina (32%) or ACS (19%). Conclusion. A significant part of patients (about 1/3) terminates the recommended therapy within 12 months after ACS. Low adherence to therapy is often determined by subjective factors and associated with a 3-fold increased risk of cardiovascular events (RR 3.27; 95% CI 2.49-4.30; p=0.05).

Keywords

• ischemic heart disease
• acute coronary syndrome
• adherence to therapy
• prognosis
• efficacy of therapy