Assessing optimal medical therapy adherence following acute coronary syndrome utilising telehealth cardiology pharmacist clinics

Abstract

Abstract Background: Optimal medical therapy (OMT) following acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI) is a predictor of future major adverse cardiovascular events (MACE). Underutilisation of OMT is associated with higher risk of MACE within Australian populations. Aims: Effects of a telehealth cardiology pharmacist clinic (TCPC) on patient adherence to OMT and MACE in patients who received PCI for ACS. Methods: Retrospective matched cohort study within a large regional health service comparing patient populations before and after implementation of post-PCI TCPC with twelve-month follow up. Patients who received PCI for ACS were consulted by the pharmacist at one, three- and twelve-months’. Matching criteria included age, sex, presence of left ventricular dysfunction and ACS type. Primary outcome was difference in adherence to OMT at twelve months post PCI. Secondary outcomes included 4-point MACE at twelve months and validation of self-reported adherence using medication possession ratios from pharmacy dispensing records. Results: There were 156 patients in this study (78 matched pairs). Analysis of adherence to OMT at twelve months demonstrated an absolute increase in adherence to OMT by 13% (31 vs. 44%, p = 0.038). Furthermore, sub-optimal medication therapy (less than ACS medication groups at twelve months) reduced by 23% (31–8%, p = 0.004). MACE at twelve months reduced by 23% (31 vs.8% p = 0.004). Conclusions: This novel intervention significantly improved adherence at to OMT at twelve months; a demonstrated contributor to clinical outcomes. Primary and secondary outcomes in the intervention group were both statistically significant. Pharmacist-led follow up is both cost effective and improves patient outcomes.