A non-physician health worker-led educational intervention significantly improved adherence to antiplatelets (92.0% vs 77.1%) and statins (94.0% vs 70.8%) at 12 months compared to standard care in patients following acute coronary syndrome.
RCT (n=100)
Open-label
1:1 ratio via centralized telephone service
No
Does a non-physician health worker-led educational intervention improve adherence to secondary prevention medications and healthy lifestyles in patients following acute coronary syndrome?
A non-physician health worker-led educational intervention significantly improves long-term adherence to evidence-based medications and healthy lifestyles in patients discharged after an acute coronary syndrome.
Absolute Event Rate: 92% vs 77.1%
p-value: p=0.040
OBJECTIVE: To evaluate usefulness of non-physician health workers (NPHW) to improve adherence to medications and lifestyles following acute coronary syndrome (ACS). METHODS: We randomized 100 patients at hospital discharge following ACS to NPHW intervention (n=50) or standard care (n=50) in an open label study. NPHW was trained for interventions to improve adherence to medicines - antiplatelets, β-blockers, renin-angiotensin system (RAS) blockers and statins and healthy lifestyles. Intervention lasted 12 months with passive follow-up for another 12. Both groups were assessed for adherence using a standardized questionnaire. RESULTS: ST elevation myocardial infarction (STEMI) was in 49 and non-STEMI in 51, mean age was 59.0±11 years. 57% STEMI were thrombolyzed. On admission majority were physically inactive (71%), consumed unhealthy diets (high fat 77%, high salt 58%, low fiber 57%) and 21% were smokers/tobacco users. Coronary revascularization was performed in 90% (percutaneous intervention 79%, bypass surgery 11%). Drugs at discharge were antiplatelets 100%, β-blockers 71%, RAS blockers 71% and statins 99%. Intervention and control groups had similar characteristics. At 12 and 24 months, respectively, in intervention vs control groups adherence (>80%) was: anti platelets 92.0% vs 77.1% and 83.3% vs 40.9%, β blockers 97.2% vs 90.3% and 84.8% vs 45.0%), RAS blockers 95.1% vs 82.3% and 89.5% vs 46.1%, and statins 94.0% vs 70.8% and 87.5% vs 29.5%; smoking rates were 0.0% vs 12.5% and 4.2% vs 20.5%, regular physical activity 96.0% vs 50.0%, and 37.5% vs 34.1%, and healthy diet score 5.0 vs 3.0, and 4.0 vs 2.0 (p<0.01 for all). Intervention vs standard group at 12 months had significantly lower mean systolic BP, heart rate, body mass index, waist:hip ratio, total cholesterol, triglyceride, and LDL cholesterol (p<0.01). CONCLUSIONS: NPHW-led educational intervention for 12 months improved adherence to evidence based medicines and healthy lifestyles. Efficacy continued for 24 months with attrition.
Sharma et al. (Sat,) conducted a rct in Acute coronary syndrome (n=100). Non-physician health worker (NPHW) educational intervention vs. Standard care was evaluated on Adherence (>80%) to antiplatelets at 12 months (p=0.040). A non-physician health worker-led educational intervention significantly improved adherence to antiplatelets (92.0% vs 77.1%) and statins (94.0% vs 70.8%) at 12 months compared to standard care in patients following acute coronary syndrome.
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