Abstract
Studies of secondary prevention for cardiovascular disease show low fulfilment of guideline-recommended targets. This study explored whether nurse-led follow-up could increase adherence to statins over time and reasons for discontinuation. All patients admitted for acute coronary syndrome at Östersund hospital between 2010–2014 were screened for the randomized controlled NAILED-ACS trial. The trial comprises two groups, one with nurse-led annual follow-up and medical titration by telephone to reach set intervention targets and one with usual care. All discontinuations of statins were recorded prospectively for at least 36 months and categorized as avoidable or unavoidable. Kaplan-Meier estimates were conducted for first and permanent discontinuations. Predictors for discontinuation were analysed using multivariate Cox regression, statin type and mean LDL-C at end of follow-up. Female gender was a predictor for discontinuation. Allocation in the intervention group predicted increased risk for a first but decreased risk for permanent discontinuation. A nurse-led telemedical secondary prevention programme in a relatively unselected ACS cohort leads to increased adherence to statins over time, greater percentage on potent treatment and lower LDL-C compared to usual care. An initially increased tendency toward early discontinuation in the intervention group stresses the importance of a longer duration of structured follow-up.
Highlights
Statin use in secondary prevention after acute coronary syndrome (ACS) is one of the most researched areas in cardiovascular medicine
This study aimed to prospectively measure long-term adherence to statins in the Nurse-based Age-independent Intervention to Limit Evolution of Disease after Acute Coronary Syndrome (NAILED ACS) trial and assess whether the intervention improved adherence compared with usual care
There were no significant differences in baseline characteristics (Table 1)
Summary
Statin use in secondary prevention after acute coronary syndrome (ACS) is one of the most researched areas in cardiovascular medicine. Statins are thought to be affected by negative expectations about side effects and effect of treatment, the nocebo effect. These psychological beliefs are influenced by the perceptions of patients, physicians and the media, and may influence long-term adherence[6]. There is a lack of data from long-term, prospective, randomized, controlled adherence studies in fairly unselected populations as wells as data concerning the exact reasons for treatment discontinuation. This study aimed to prospectively measure long-term adherence to statins in the Nurse-based Age-independent Intervention to Limit Evolution of Disease after Acute Coronary Syndrome (NAILED ACS) trial and assess whether the intervention improved adherence compared with usual care.
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