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Early Drug Non-Adherence After Acute Myocardial Infarction

Early Drug Non-Adherence After Acute Myocardial Infarction

Mortality rates associated with heart disease have declined in recent years throughout the United States in large part because of evidence-based therapies that help reduce risks of recurrent cardiovascular adverse events. When patients suffer an initial myocardial infarction (MI) and are treated in the hospital, they are prescribed evidence-based cardiovascular therapies. However, simply writing a prescription does not necessarily translate into downstream adherence after they leave the hospital. Previous research has shown that patient adherence to prescribed therapies is suboptimal with some reports estimating that more than 25% of patients do not fill their prescriptions within a week of being discharged after an acute MI. “Medication non-adherence after MI is a widely recognized problem in healthcare and has been linked to worse patient outcomes and higher healthcare costs,” says Robin Mathews, MD. “A better understanding of the modifiable factors that contribute to non-adherence may help us develop interventions to help optimize patient outcomes.”   Longitudinal Observations In a study published in Circulation: Cardiovascular Quality & Outcomes, Dr. Mathews and colleagues assessed medication adherence among 7,425 acute MI patients who were treated with PCI at 216 U.S. hospitals over a period of 2 years. The institutions involved in the study participated in TReatment with ADP receptor iNhibitorS: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS), a longitudinal observational study of PCI-treated MI. “There are many reasons why medication adherence is poor among cardiac patients,” Dr. Mathews says. “TRANSLATE-ACS is unique in that it allows us to evaluate both patient and provider factors that may contribute to non-adherence.” TRANSLATE-ACS provides data that can be used to determine...
CME: Smoking Cessation After PCI

CME: Smoking Cessation After PCI

It has been well-documented in clinical studies that smoking cessation after patients undergo PCI can improve outcomes. Some research has identified certain predictors of smoking cessation after PCI, including previous cigarette consumption and the number of coexisting coronary artery disease risk factors. Few studies, however, have assessed current trends in smoking cessation after PCI and looked at the potential impact of smoke-free policies that are being enacted throughout many parts of the United States. “Historically, patients who undergo PCI are a group that has more difficulty quitting smoking than others,” says Randal J. Thomas, MD, MS. The Effect of Smoke-Free Policies In a study published in the February 15, 2015 issue of the American Journal of Cardiology, Dr. Thomas and colleagues assessed trends and predictors of smoking cessation after PCI in Olmsted County, Minnesota. The investigators conducted the research at a time when local and statewide smoke-free public policies were enacted in Olmsted County. The study followed 2,306 patients who underwent their first PCI from 1999 to 2009 for 12 months. The researchers conducted structured telephone surveys at 6 and 12 months after PCI to assess smoking status and quit rates during the 10-year period. The authors paid particular attention to quite rates around two dates when three smoke-free ordinances were implemented to reduce secondhand tobacco exposure in Olmsted County. The first date was January 1, 2002, when an ordinance was passed requiring restaurants to be smoke-free. The second was October 1, 2007, when ordinances required both workplaces and the entire state of Minnesota to be smoke-free. The data were then analyzed according to three time periods: 1991 to 2001, 2002...
Smoking Cessation After PCI

Smoking Cessation After PCI

It has been well-documented in clinical studies that smoking cessation after patients undergo PCI can improve outcomes. Some research has identified certain predictors of smoking cessation after PCI, including previous cigarette consumption and the number of coexisting coronary artery disease risk factors. Few studies, however, have assessed current trends in smoking cessation after PCI and looked at the potential impact of smoke-free policies that are being enacted throughout many parts of the United States. “Historically, patients who undergo PCI are a group that has more difficulty quitting smoking than others,” says Randal J. Thomas, MD, MS. The Effect of Smoke-Free Policies In a study published in the February 15, 2015 issue of the American Journal of Cardiology, Dr. Thomas and colleagues assessed trends and predictors of smoking cessation after PCI in Olmsted County, Minnesota. The investigators conducted the research at a time when local and statewide smoke-free public policies were enacted in Olmsted County. The study followed 2,306 patients who underwent their first PCI from 1999 to 2009 for 12 months. The researchers conducted structured telephone surveys at 6 and 12 months after PCI to assess smoking status and quit rates during the 10-year period. The authors paid particular attention to quite rates around two dates when three smoke-free ordinances were implemented to reduce secondhand tobacco exposure in Olmsted County. The first date was January 1, 2002, when an ordinance was passed requiring restaurants to be smoke-free. The second was October 1, 2007, when ordinances required both workplaces and the entire state of Minnesota to be smoke-free. The data were then analyzed according to three time periods: 1991 to 2001, 2002...
Guidance for PCI Without On-Site Surgical Backup

Guidance for PCI Without On-Site Surgical Backup

In 2007, the Society for Cardiovascular Angiography and Interventions (SCAI) published an expert consensus document on the current status and future direction of PCI without on-site surgical backup. The document reviewed the existing literature and examined recommendations for performing PCI in this setting from several existing programs and other sources, thereby defining best practices for facilities and operators. “Since that time, new studies, meta-analyses, and randomized trials have been published in which PCI with and without on-site surgery has been compared,” says Gregory J. Dehmer, MD, FACC, FACP, FSCAI. “In addition, professional organizations have published appropriate use criteria for coronary revascularization and other documents affecting the practice of PCI.” According to Dr. Dehmer, several noteworthy changes occurred in PCI guidelines that were released in 2011. “Elective PCI was upgraded to Class IIb, and primary PCI was upgraded to Class IIa at facilities without on-site surgery,” he says. In addition to the PCI guidelines, expert consensus documents and competency documents related to PCI plus additional research have provided more information on ways to optimize the structure and operation of PCI programs without on-site surgery. Consolidating Recommendations In 2014, SCAI—in collaboration with the American College of Cardiology and the American Heart Association—released a new expert consensus document on PCI at sites without on-site surgical backup. This document consolidates the myriad of recommendations that have been released in different forms since the 2007 document. “The recommendations are designed to improve safety while maintaining access to quality care,” says Dr. Dehmer, who was lead author of both the 2007 and 2014 consensus documents. As cited in the new document, 11 original studies and...
Cardiac Tests & Treatments to Avoid

Cardiac Tests & Treatments to Avoid

In collaboration with the American Board of Internal Medicine’s Choosing Wisely campaign, the Society for Cardiovascular Angiography and Interventions (SCAI) has issued a list of five specific, evidence-based recommendations that should be avoided in the care of patients who have cardiovascular disease (CVD) or are at risk for it. “This list should be used to spur conversations between patients and physicians so that wise decisions are made about care based on each patient’s individual situation,” says James C. Blankenship, MD. “It’s hoped that this list will improve care for patients and eliminate unnecessary tests and procedures.” Five Recommendations for Patients with CVD The list of tests and treatments to avoid from SCAI includes the following five recommendations: 1. Avoid routine stress testing after PCI without specific clinical indications. 2. Avoid coronary angiography in post-bypass surgery and post-PCI patients who are asymptomatic or who have normal or mildly abnormal stress tests and stable symptoms that do not limit quality of life. 3. Avoid coronary angiography for risk assessment in patients with stable ischemic CVD who are unwilling to undergo revascularization or who are not candidates for revascularization based on comorbidities or individual preferences. 4. Avoid coronary angiography to assess risk in asymptomatic patients with no evidence of ischemia or other abnormalities on adequate non-invasive testing. 5. Avoid PCI in asymptomatic patients with stable ischemic CVD without the demon­stration of ischemia on adequate stress testing or with abnormal fractional flow reserve testing. The list was based on guidelines and appropriate use criteria developed by SCAI, the American College of Cardiology, the American Heart Asso­ciation, and other professional societies. All of the...
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