Purpose: the prevalence of low adherence (A) in coronary artery disease (CAD) can be up to 43%; is associated with poor control of coronary risk factors, but also facilitates the recurrence of the disease. We evaluated the effects of an outpatient education program,made exclusively by nurses, after an acute coronary syndrome (ACS)
Methods: 82 P (64.6% men and 35.4% women, mean age 68.3 ± 12.7), after an ACS, at 15 days, 3 months and 6 months were subjected to a comprehensive nursing education sessions supervised by cardiologists. The topics of discussions were: information on coronary risk factors and healthy lifestyles; targets, frequency,doses, side effects of drugs and its chemical and trade name; filling of a diary to record the dose and when taking the drug; simplification of the treatment regimen; involvement of caregivers particularly in the case of cognitive impairment. The questionnaire Morisky Medication Adherence Scale 8-item (MMAS) was the tool to calculate the level of A. The level of LDL-cholesterol (LDL-C) was used as an indirect assessment of the A to statins treatment. A recent historical control group of 50 P usual care was used for comparison.
Results: at sixth month on the basis of the results MMAS, 9 (11%) of P had low, 22 (26.8%) average, and 51 (62.2%) high AT. In the control group, the results were, respectively, 10 (20%), 22 (44%) and 18 P (36%). Thus, 37.8% of P were non-adherent compared with 64% of the usual care group. Also the number of P that reached the LDL-C target (<70mg/dl) was higher than in the control group (67, 81.7% vs. 19, 38%, p <.01).
Conclusions: despite the benefits of secondary prevention, the medium term mortality and morbidity after ACS is still too high. Low A and medical inertia can adversely affect the P outcomes. An education coronary program, managed entirely by nurses, but under the supervision of a cardiologist can improve the level of A to the prescribed therapy. This implies a better LDL-C control, a major coronary risk factor whose positive impact on the prognosis of coronary patients is well known.