Role of community pharmacists in improving adherence and clinical outcomes after acute coronary syndromes (IM-ADHERENCE): six month-results
Authors: Picariello C , Vighesso E , Ruzza R , Ferrarese A , Roncon L 
Published: November 2020

Abstract

Background
Acute coronary syndromes (ACS) are the leading cause of death from cardiovascular diseases (CVD) and are responsible for 8% of deaths in Italy. Available data evaluating patient long-term adherence show that about 20–30% of patients interrupts medical therapy within first six months from the index event. Although several strategies have been developed to improve adherence, there are few data evaluating the role of community pharmacist on patient adherence and its impact on clinical outcomes

Purpose
Our aim was to evaluate if involving community pharmacists could improve patients' adherence to medical prescriptions after ACS, reducing the rate of re-admissions due to CVD and related costs (IM-ADHERENCE study). We report the results of the first six months of the study.

Methods
Patients discharged for ACS from February to September 2018 in three main hospitals of our city area, in active therapy with at least one of the recommended drugs for secondary prevention (ASA, P2Y12, statin), were identified by a cardiologist to be included in the interventional arm. Patient's drug reconciliation was obtained by the hospital pharmacist before discharge. An adherence plan assessment was performed by the referral community pharmacist at 30 days, 3, 6, 9 and 12 months after discharge with 3 kinds of interventions: counseling, pill counts and self-administered questionnaire on adherence. The cardiologist also identified patients discharged within 6 months before the study beginning as historical control arm. The investigators collected the data from pill counts, questionnaire results on adherence (interventional arm) and administrative databases throughout 6 months from hospital discharge. Main outcome was the rate of adherent patients after 6 months, defined as a value of Proportion of Days Covered (PDC) &gt;80% (chi square test; p&lt;0.05). Secondary outcomes concerned re-admission rates due to CV events and related costs.

Results
A total of 128 patients were identified, 61 patients were enrolled in the interventional arm (age 68±12,3; 87% male; 15 drop-out included in the analysis). The interventional and control arms had the same sample size and were comparable. At 6 months, the interventional arm compared with control had a higher rate of adherent patients (51% vs 33%, p=0.046) and a lower rate of re-admission to hospital for CV events (46% vs 69%, p=0.01). A significant reduction in health costs was obtained as lower rate of hospitalizations (about € 207.501 in 6 months).

Conclusions
The intervention of community pharmacist in patient drug adherence after ACS reduced re-hospitalizations and health costs at 6 months from index event. This study was an opportunity to integrate hospital and community pharmacists with cardiologist work in treatment and outcome of ACS patients, achieving medication reconciliation and a higher drug adherence, with less re-hospitalizations. These data are waiting to be confirmed at 1-year analysis.

Funding Acknowledgement
Type of funding source: None