[Impact of different intervention models on adherence to secondary prevention therapies in patients with acute coronary syndrome].

Objective: To evaluate the impact of different intervention models on adherence to secondary prevention therapies in patients with acute coronary syndrome (ACS). Methods: This multi-center cross-sectional study collected data from 34 hospitals covering 22 provinces in China. Hospitals were randomly divided into four groups: control group(routine treatment and care), promotional calendar group (routine treatment and care plus giving propaganda desk calendar to patients), education group (routine treatment and care add patients education by nurses) and combined intervention group (promotional calendar and education).At least 90 patients with ACS were consecutively enrolled from each involved hospital from April 15, 2012 to June 30, 2013. To reduce the impact of uneven distribution of inter-group variables on the results, 1∶1∶1∶1 propensity score matching method was used. The drug usage for secondary prevention and prognosis wasobtainedat 6 months after hospital discharge. Results: (1) A total of 3 391 patients were selected and 2 244 patients were included for the final analysisafter propensity score analysis. (2) At 6 months after discharge, the adherence rates of antiplatelet, statins, angiotensin converting enzyme inhibitor(ACEI)/angiotensin Ⅱ receptor blocker(ARB), β-blocker and the combination of 4 medications were similar between control group and promotional calendar group (all P> 0.016).The adherence rates of antiplatelet and statins were 97.0% (526/542) and 91.0% (493/542) in the education group, 3.7% and 5.5% higher than in the control group (both P< 0.016). The adherence rates of statins,ACEI/ARB and combined medication were 91.0% (496/545), 68.3% (372/545) and 53.2% (290/545) in the combined intervention group,significantly higher than in the control group (5.5%,8.3% and 9.6%, all P< 0.016). (3) Poisson regression analysis showed that the adherence of antiplatelet drugs in the education group was 3.4%( OR= 1.034, 95% CI 1.007-1.060, P< 0.05) and 3.5%( OR= 1.035, 95% CI 1.007-1.063, P< 0.05) higher than in the control group and the promotional calendar group, and the statins adherence rate was 5.5%( OR= 1.055, 95% CI 1.012-1.101, P< 0.05) higher than in the control group. The antiplatelet drug adherence rates in the combined intervention group were 3.0% ( OR= 1.030, 95% CI 1.002-1.058, P< 0.05) and 3.1% ( OR= 1.031, 95% CI 1.003-1.060, P< 0.05) higher than in the control group and the promotional calendar group, respectively, and statin adherence was 6.1% ( OR= 1.061, 95% CI 1.017-1.107, P< 0.01) higher than in the control group. The adherence rates of ACEI/ARB in combined intervention group were respectively 15.4%( OR= 1.154, 95% CI 1.057-1.259, P< 0.01),20.0%( OR= 1.200, 95% CI 1.096-1.314, P< 0.01) and 25.5%( OR= 1.255, 95% CI 1.142-1.380, P< 0.01) higher than in the control group, promotional calendar group and education group. The adherence rates of combined medication in combined intervention group were respectively 21.6%( OR= 1.216, 95% CI 1.079-1.371, P< 0.01),21.5%( OR= 1.215, 95% CI 1.077-1.371, P< 0.01) and 27.8%( OR= 1.278, 95% CI 1.126-1.450, P< 0.01) higher than in the control group, promotional calendar group and education group. (4) At 6 months after discharge, the control rates of blood pressure (<140/90 mmHg,1 mmHg=0.133 kPa) in the education group were significantly higher than in the control group and promotional calendar group (78.7% (398/506) vs. 70.2%(373/531) and 71.1% (354/498) , all P< 0.016),and the control rates of blood pressure in combined intervention group were higher than in the control group and promotional calendar group (78.2% (376/481) vs. 70.2%(373/531) and 71.1% (354/498) , all P< 0.016).The rehospitalization rates were 7.0% (39/561) in the promotional calendar group, and 7.6% (42/561) in the education group, both significantly higher than in the control group (3.8% (21/561), all P< 0.016).The rate of the low density lipoprotein cholesterol<2.07 mmol/L and the rate for all-cause mortality were similar among groups (all P> 0.016) . Conclusion: Post-discharge medication adherence in ACS patients can be enhanced by either promotional calendaror nurses education strategy, and the efficacy is better by nurse education as compared with promotional calendar, the combination of both methods can further increase the post-discharge medication adherence rates in ACS patients.