Abstract 71: Evaluating The Factors Associated With Patient Adherence And Persistence To Pharmacological Therapies After An Acute Coronary Syndrome

Adherence to guideline-recommended, long-term, secondary preventative therapies among patients with acute coronary syndromes (ACS) is fundamental to improving long-term outcomes. This review identified factors that influence medication adherence among patients following an ACS. A targeted literature review was conducted on September 7, 2021 using predefined search strategies to identify studies that investigated adherence to secondary preventative oral therapies post-ACS. Embase and MEDLINE® were searched using the Ovid platform. A total of 58 studies were identified. Adherence to secondary prevention was moderate to low and steadily decreased over time. Nearly 30% of patients discontinued one or more medications within 90 days of their primary ACS, and adherence decreased to 50-60% at one-year post-discharge. There were no major differences in adherence between drug classes. Three key factors influenced adherence: clinical, psychological, and follow-up care. Patients managed with percutaneous coronary interventions were more adherent to follow-up treatment than medically-managed patients. Depression was reported as a major psychological factor that negatively affected adherence. Improved adherence was observed when higher levels of patient education and provider engagement were delivered during post-discharge follow-up. Notably, early follow-up visits were associated with high adherence. In a US study, two-year major adverse cardiovascular event incidence was lower in hospitals with high 90-day medication adherence than those with moderate or low adherence. Patient non-adherence to guideline-recommended long-term pharmacological secondary preventative therapies post-ACS is a multi-factorial problem. A comprehensive multi-disciplinary approach, with key interventions such as early follow-up visits, patient engagement and education, should be implemented to improve adherence and clinical outcomes. Additionally, novel therapies with a short treatment course that can be completed within 90 days, while possessing patient and provider preferred attributes such as good tolerability, convenient dosing and administration, may help to improve patient adherence and clinical outcomes.