Abstract

Studies of secondary prevention for cardiovascular disease show low fulfilment of guideline-recommended targets. This study explored whether nurse-led follow-up could increase adherence to statins over time and reasons for discontinuation. All patients admitted for acute coronary syndrome at Östersund hospital between 2010–2014 were screened for the randomized controlled NAILED-ACS trial. The trial comprises two groups, one with nurse-led annual follow-up and medical titration by telephone to reach set intervention targets and one with usual care. All discontinuations of statins were recorded prospectively for at least 36 months and categorized as avoidable or unavoidable. Kaplan-Meier estimates were conducted for first and permanent discontinuations. Predictors for discontinuation were analysed using multivariate Cox regression, statin type and mean LDL-C at end of follow-up. Female gender was a predictor for discontinuation. Allocation in the intervention group predicted increased risk for a first but decreased risk for permanent discontinuation. A nurse-led telemedical secondary prevention programme in a relatively unselected ACS cohort leads to increased adherence to statins over time, greater percentage on potent treatment and lower LDL-C compared to usual care. An initially increased tendency toward early discontinuation in the intervention group stresses the importance of a longer duration of structured follow-up.

Details

Title
Statin treatment after acute coronary syndrome: Adherence and reasons for non-adherence in a randomized controlled intervention trial
Author
Huber, Daniel 1 ; Wikén, Christian 1 ; Henriksson, Robin 1 ; Söderström Lars 2 ; Mooe, Thomas 1 

 Unit of Research, Education and Development - Östersund, Umeå University, Department of Public Health and Clinical Medicine, Östersund, Sweden (GRID:grid.12650.30) (ISNI:0000 0001 1034 3451) 
 Region Jämtland Härjedalen, Östersund Hospital, Unit of Research, Development and Education, Östersund, Sweden (GRID:grid.477667.3) (ISNI:0000 0004 0624 1008) 
Publication year
2019
Publication date
2019
Publisher
Nature Publishing Group
e-ISSN
20452322
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2500686325
Copyright
© The Author(s) 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.