Ho, P MichaelLambert-Kerzner, AnneCarey, Evan PFahdi, Ibrahim EBryson, Chris LMelnyk, S DeeBosworth, Hayden BRadcliff, TiffanyDavis, RyanMun, HowardWeaver, JenniferBarnett, CaseyBarón, AnnaDel Giacco, Eric J2024-02-012024-02-012014-022168-61062168-6114https://hdl.handle.net/10161/30010<h4>Importance</h4>Adherence to cardioprotective medication regimens in the year after hospitalization for acute coronary syndrome (ACS) is poor.<h4>Objective</h4>To test a multifaceted intervention to improve adherence to cardiac medications.<h4>Design, setting, and participants</h4>In this randomized clinical trial, 253 patients from 4 Department of Veterans Affairs medical centers located in Denver (Colorado), Seattle (Washington); Durham (North Carolina), and Little Rock (Arkansas) admitted with ACS were randomized to the multifaceted intervention (INT) or usual care (UC) prior to discharge.<h4>Interventions</h4>The INT lasted for 1 year following discharge and comprised (1) pharmacist-led medication reconciliation and tailoring; (2) patient education; (3) collaborative care between pharmacist and a patient's primary care clinician and/or cardiologist; and (4) 2 types of voice messaging (educational and medication refill reminder calls).<h4>Main outcomes and measures</h4>The primary outcome of interest was proportion of patients adherent to medication regimens based on a mean proportion of days covered (PDC) greater than 0.80 in the year after hospital discharge using pharmacy refill data for 4 cardioprotective medications (clopidogrel, β-blockers, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors [statins], and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers [ACEI/ARB]). Secondary outcomes included achievement of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) level targets. RESULTS Of 253 patients, 241 (95.3%) completed the study (122 in INT and 119 in UC). In the INT group, 89.3% of patients were adherent compared with 73.9% in the UC group (P = .003). Mean PDC was higher in the INT group (0.94 vs 0.87; P< .001). A greater proportion of intervention patients were adherent to clopidogrel (86.8% vs 70.7%; P = .03), statins (93.2% vs 71.3%; P < .001), and ACEI/ARB (93.1% vs 81.7%; P = .03) but not β-blockers (88.1% vs 84.8%; P = .59). There were no statistically significant differences in the proportion of patients who achieved BP and LDL-C level goals.<h4>Conclusions and relevance</h4>A multifaceted intervention comprising pharmacist-led medication reconciliation and tailoring, patient education, collaborative care between pharmacist and patients' primary care clinician and/or cardiologist, and voice messaging increased adherence to medication regimens in the year after ACS hospital discharge without improving BP and LDL-C levels. Understanding the impact of such improvement in adherence on clinical outcomes is needed prior to broader dissemination of the program.<h4>Trial registration</h4>clinicaltrials.gov Identifier: NCT00903032.Cardiotonic AgentsPrognosisPatient DischargeRetrospective StudiesFollow-Up StudiesInterprofessional RelationsPhysician-Patient RelationsTime FactorsPatient Education as TopicAcute Coronary SyndromeMedication AdherenceSecondary PreventionJournal article