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Telephone support after stenting improved patient adherence to dual antiplatelet therapy
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Regular telephone contact after drug-eluting stent implantation significantly improved patient adherence to dual antiplatelet therapy at 1 year, according to results from EASY-IMPACT presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
Three hundred patients (mean age, 63 years; 73% men; 35% diabetic) were recruited for the Early Discharge after Transradial Stenting of Coronary Artery-Improving Adherence to Clopidogrel trial (EASY-IMPACT). Patients had a median of two drug-eluting stents implanted. Researchers randomly assigned each patient to standard care or telephone follow-up (intervention group) after implantation. Both groups were instructed on the importance of dual antiplatelet therapy before leaving the hospital, and the intervention group also received phone calls from a nurse 7 days after stenting and again at 1, 6 and 9 months. During the calls, the nurse checked in to see whether the patient was taking dual antiplatelet therapy as prescribed, inquired about problems with excess bruising or bleeding, and reinforced the importance of continuing therapy, according to a press release.
At 1 year, adherence to aspirin and clopidogrel (Plavis, Sanofi Aventis) were each 99.2% in the intervention group as compared with 90.2% adherence for aspirin and 91.5% adherence for clopidogrel in standard care group (P<.0001). Medication adherence was defined as the proportion of aspirin and clopidogrel pills each patient took during the 12-month study period compared with the number they would be expected to have taken.
Researchers also calculated medication persistence, which they defined as having less than a 14-day gap between expected and actual prescription refill dates at any point in the study, according to a press release. For aspirin, 91.2% of patients in the intervention group remained persistent at 6 months vs. 72.3% of patients in the control group (P<.0001). At 1 year, 87.8% of the intervention group and 39% of the control group remained persistent. Similar results were found with clopidogrel: 90.5% of the intervention group and 66.7% of the control group remained persistent at 6 months, and 87.2% of the intervention group and 43.1% of the control group were still persistent at 1 year (P<.0001 for both).
“We should make every effort to make sure patients do not interrupt dual antiplatelet therapy once they’ve received a drug-eluting stent,” Stephane Rinfret, MD, FSCAI, a clinical and interventional cardiology researcher at Quebec Heart and Lung Institute, stated in the release.
For more information:
- Rinfret S. Abstract A-017. Presented at: the Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 9-12, 2012; Las Vegas.
Perspective
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J.P. Reilly, MD, FACC
We know that, despite our best efforts, when physicians talk to patients either in the clinic or at discharge, patients are often overwhelmed by the new information they retained and will probably remember less than half of what we told them by the time they get home. That is important to note, no matter how careful physicians are when giving the first information.
The researchers had to improve one very important thing: adherence to medication. This study employed a very simple strategy. Importantly, it is something that can be easily duplicated in each of our practices. Physicians need to assign themselves, a nurse or someone else in the office to make those phone calls. It is simple in that there is not a lot of other equipment or additional costs, aside from time and opportunity costs. It is a great strategy to improve adherence to medication and although this study was about dual antiplatelet therapy, I think the person making the phone calls could be giving reminders about other medications, such as statins, beta-blockers and BP medicines. Exercise and living a healthy lifestyle are also important, and I’d wager that this same intervention may be as effective.
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