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Statin treatment after acute coronary syndrome: long-term persistence and reasons for non-persistence
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Section of Cardiology, Dept of Internal Medicine, Östersund Hospital, Östersund Sweden, Östersund, Sweden.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Section of Cardiology, Dept of Internal Medicine, Östersund Hospital, Östersund Sweden, Östersund, Sweden.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Section of Cardiology, Dept of Internal Medicine, Östersund Hospital, Östersund Sweden, Östersund, Sweden.
2018 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 1102-1103Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Secondary prevention after acute coronary syndrome (ACS) is crucial to prevent recurrent events. Multiple studies however show that patients often end treatments and for reasons unknown. Our aims in this study were to perform a prospective follow-up of persistence to statin treatment in a population based patient cohort after ACS, to explore the reasons for discontinuation, and to determine whether a nurse-based follow-up could improve persistence.

Methods: We studied patients recruited between 2010–2014 in the ongoing randomised controlled NAILED-ACS trial. All patients admitted with ACS at our County Hospital were eligible and exclusion criteria limited to inability to adhere to the study concept or participation in another trial. We randomised participants either to an intervention group with nurse-based telephone follow-up or to a control group with follow-up by a general practitioner (usual care). All participants were interviewed and screened yearly for blood pressure and blood lipids. The intervention group also got yearly counselling on healthy living and individualised titration of medicines to reach target values for blood pressure and blood lipids. We forwarded the measurements for the control group to the general practitioner for assessment. We collected information on adherence to statin treatment at the yearly interview and by review of medical records. Each reason for treatment discontinuation were recorded and classified as temporary or permanent.

Results: Out of 963 patients, 89.3% (n=434) in the intervention and 82.0% (n=391) in the control group were persistent to statin treatment after a median of 3.9 years of follow-up (p=0.001). The most prevalent reason for permanent discontinuation in the intervention group was advanced disease (27.5%, n=14) while in the control group it was side effects without a compelling relation to treatment (32.8%, n=22). A total of 27.8% (n=135) of the patients in the intervention group and 20.5% (n=98) in the control group discontinued treatment at some point during the period (p=0.009). The most common reasons for a first discontinuation were in both arms side effects without a compelling relation to treatment and lack of treatment motivation.

Conclusion: A nurse-based, long-term follow-up by telephone after an ACS with individualised medical adjustments results in a higher persistence to statin treatment than usual care.

Place, publisher, year, edition, pages
Oxford University Press, 2018. Vol. 39, p. 1102-1103
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
URN: urn:nbn:se:umu:diva-157618DOI: 10.1093/eurheartj/ehy566.P5378ISI: 000459824003469OAI: oai:DiVA.org:umu-157618DiVA, id: diva2:1299358
Conference
European-Society-of-Cardiology Congress, AUG 25-29, 2018, Munich, GERMANY
Note

Supplement: 1

Meeting Abstract: P5378

Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-03-26Bibliographically approved

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Huber, DanielHenriksson, RobinMooe, Thomas

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