Assessment of telehealth cardiology pharmacist clinic in improving therapy adherence following acute coronary syndrome and PCI.

Abstract

Background: Advances in percutaneous coronary intervention (PCI) have contributed to increased survival following acute coronary syndromes (ACS). Optimal medical therapy (OMT)—ACE inhibitor, aspirin, P2Y12 inhibitor, statin, beta blocker—is paramount for secondary prevention of Major Adverse Cardiovascular Events (MACE). Studies have shown real-world adherence for cardiovascular medications post-ACS can be as low as 50%. New interventions are required. Aim: Does patient participation in a cardiology pharmacist clinic following PCI in ACS improve 12-month adherence to OMT? Method: Retrospective matched cohort study utilising Melbourne Interventional Group data, compared before and after implementation of post-PCI pharmacist telehealth clinic. Patients were consulted by the pharmacist at one month, three months and twelve months’ post PCI. Matching criteria included age, sex, presence of left ventricular dysfunction and type of ACS. Secondary endpoints include changes to 4-point MACE. Results: 473 patients yielded 78 matched pairs (n=156). 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 (three or less ACS medications at twelve months) reduced by 23% (31% to 8%, p=0.004). MACE at twelve months reduced by 23% (31% vs 8%, p=0.004). Conclusion: The pharmacist clinic demonstrated a novel intervention delivered via telehealth significantly improved adherence at to OMT at twelve months; a demonstrated contributor to mortality and morbidity outcomes for post ACS patients. Primary and secondary outcomes in the intervention group were both statistically significant. Pharmacist led follow up is both cost effective and improves patient outcomes.