Reinforcing Adherence to Lipid-lowering Therapy after an Acute Coronary Syndrome: A Pragmatic Randomized Controlled Trial
Аннотация
Abstract Aims: Achieving the low-density lipoprotein cholesterol (LDL-C) goal following an acute coronary syndrome (ACS) is a milestone often missed due to suboptimal adherence to secondary prevention treatments. Whether improved adherence could result in reduced LDL-C levels is unclear. We aimed to evaluate an educational-motivational intervention to increase long-term lipid-lowering therapy (LLT) adherence and LDL-C goal attainment rate among post-ACS patients. Methods: IDEAL-LDL was a parallel, two-arm, single-center, pragmatic, investigator-initiated randomized controlled trial. Hospitalized patients for ACS were randomized to a physician-led integrated intervention consisting of an educational session at baseline, followed by regular motivational interviewing phone sessions or usual care. Co-primary outcomes were the LLT adherence (measured by Proportion of Days Covered (PDC); good adherence defined as PDC>80%), and LDL-C goal (<70 mg/dl or 50% reduction from baseline) achievement rate at one year. Results: In total, 360 patients (mean age 62 years, 81% male) were randomized. Overall, good adherence was positively associated with LDL-C goal achievement rate at one year. Median PDC was higher in the intervention group than the control group [0.92 (IQR, 0.82–1.00) vs. 0.86 (0.62–0.98); p=0.03] while the intervention group had increased odds of good adherence (adjusted odds ratio: 1.76 (95% confidence interval 1.02 to 2.62; p=0.04). However, neither the rate of LDL-C goal achievement (49.6% in the intervention vs. 44.9% in the control group; p=0.49) nor clinical outcomes differed significantly between the two groups. Conclusion: Α multifaceted intervention improved LLT adherence in post-ACS patients without a significant difference in LDL-C goal attainment. (IDEAL-LDL, ClinicalTrials.gov: NCT02927808)