Educational intervention to improve adherence after acute coronary syndrome.

Abstract

Introduction: Patients discharged with a diagnosis of acute coronary syndrome (ACS) are at increased risk for recurrent cardiovascular events. Improved adherence to treatment has been associated with better outcomes. The objective of this study was to evaluate the effect of an educational intervention on medication adherence in patients following ACS.

Materials and methods: A single-center, randomized, open-label, controlled clinical trial with parallel groups and a six-month follow-up.

Results: Sixty-three patients were randomized to the mixed educational intervention group and sixty-nine to the control group. Baseline characteristics were similar between groups: 82.6% were male, with a median age of 56 years (IQR 51-61), 73.5% had completed primary education. Mean ejection fraction (EF) was 47.7% (SD 12.33). Most patients were discharged with more than four medications, with a median of seven (IQR 6.0-8.0) tablets per day. At one month, adherence was 80.0% in the intervention group and 66.2% in the control group (RR 1.21; 95% CI 0.97-1.50; p = 0.12). At three months, adherence was 79.7% vs. 77.4% (RR 1.03; 95% CI 0.85-1.24; p = 0.94), and at six months -the primary endpoint- 73.3% vs. 71.9% (RR 1.02; 95% CI 0.82-1.27; p = 1.00). No significant differences were observed between groups in the occurrence of clinical events.

Conclusion: The educational intervention was well accepted and feasible to implement, but it did not result in improved medication adherence or a reduction in clinical events over the medium term.