Date Published: June 6, 2019
Publisher: Public Library of Science
Author(s): Chih-Kuo Lee, Chao-Lun Lai, Ming-Hsien Lee, Fang-Ying Su, Tzu-Shan Yeh, Li-Ying Cheng, Mu-Yang Hsieh, Yen-Wen Wu, Yen-Bin Liu, Chih-Cheng Wu, Timir Paul.
Prescription of guideline-recommended medicines after acute coronary syndrome (ACS) has been suboptimal. Tools for improving the use of medications have been developed, but they mainly targeted physicians.
We evaluated the effects of reinforcement of patient and family education on the usage of guideline-recommended secondary prevention medications.
This was a retrospective analysis of a prospectively collected registry of patients with ACS who were admitted to a regional teaching hospital in Taiwan between February 2015 and April 2017. The control group included 76 patients discharged before implementing the electronic-based patient and family education (PFE) system. The intervention group included 206 patients discharged after implementation. The primary outcome was the prescription rate of all four guideline-recommended drugs. Predictors of adherence were also evaluated.
The study cohort included 282 ACS patients (188 men and 94 women) with a mean age of 68.5 years (standard deviation, 14.2). The intervention group patients were younger, had more family history of premature cardiovascular disease, more dyslipidemia, and underwent more reperfusion therapy. The intervention group was prescribed more guideline-recommended drugs than the control group: dual antiplatelet agents, 79.61% vs. 47.37% (p<0.001); statins, 74.76% vs. 34.21% (p<0.001); beta-blockers, 81.07% vs. 46.05% (p<0.001); angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, 62.62% vs. 38.16% (p<0.001); and a combination of all four medications, 39.32% vs. 14.47% (p<0.001). After adjusting baseline variables, the PFE system remained a significant contributor to adherence to these drugs use (P = 0.02). Reinforcement of patient education was associated with significant improvements in physicians’ adherence to guideline-recommended medical therapy after acute coronary syndrome.
Ischemic heart disease, especially acute coronary syndrome (ACS), is a leading cause of death worldwide. However, because of the introduction of reperfusion therapy, intensive care, and medications for secondary prevention, the mortality rate of ACS has declined during the past 30 years. Nonetheless, studies have shown the suboptimal use of secondary preventive medications after discharge[2–5]. This nonadherence to the guidelines-recommended drug use is associated with worse patient outcomes. Consequently, encouraging adherence to the guidelines is a relevant issue that affects the quality of care for those with ACS.
A previous nationwide registry in Taiwan and recent international registries showed that the use of guideline-recommended medications was usually suboptimal for ACS patients[2–4]. Our single-center cohort study demonstrated similar findings at a regional hospital. We found that the factor most relevant to these results was PCI during hospitalization. Additionally, significant improvements in the use of all medications were noted after implementation of the PFE system at our hospital.