Factors that Influence Patients’ Adherence to Medical Therapy Following Percutaneous Coronary Intervention

Autor: Sarah A. Hope, Ian T. Meredith, Mary-Anne Austin, Joshua Misha Lewis Casan, Mauro Baldi
Rok vydání: 2008
Předmět:
Zdroj: Heart, Lung and Circulation. 17:S90-S91
ISSN: 1443-9506
DOI: 10.1016/j.hlc.2008.05.215
Popis: Methods: Consecutive patients presenting with TTC over 14 months were evaluated. Putative myocardial inflammation was assessed acutely utilizing Technetium-99m (Tc-99m) pyrophosphate scintigraphy. We also assessed plasma CRP levels and platelet function: both aggregability and responsiveness to nitric oxide (NO). Results: Nine patients (eight women, one man; mean age 63± 11(S.D.) years) with TTC were investigated 1–7 days post-symptom onset. At acute imaging peri-apical myocardial Tc-99m pyrophosphate accumulation was increased in 6 patients. Mean CRP level was 44± 70mg/L. Mean adenosine 5′-diphosphate (2.5 mol/L)-induced platelet aggregation in whole blood (9.7± 2.7 ) was in the normal range (9.4± 2.8 ). However, response to the inhibitory effect of the NO donor sodium nitroprusside was diminished, in comparison with a normal referencegroup (25± 19%vs. 54± 24% inhibitionof aggregation, respectively) constituting platelet NO resistance. At a median follow up of 73 days, left ventricular wall motion had normalized in all cases. However, platelet NO response had normalized in only one patient. Conclusions: TTC is characterized by acute myocardial inflammatory activation and impairment of platelet response to NO, consistent with systemic redox stress. Intriguingly, in majority of the patients, platelet NO resistance persists after restoration of normal systolic function. Results: One hundred twenty-two cases have been performed (acute coronary syndromes and elective outpatients). Procedural success was 95% (116/122). There were no deaths or ST-elevation myocardial infarctions. There has been one retrieval to Sydney, which was for observation only. Groin complications were uncommon with 75% of patients receiving closure devices. There was one retroperitoneal bleed requiring blood transfusion and surgery (which was done locally). The utilisation of this service locally has improved access to PCI services for those patients unwilling or unable to travel to the city, and during times of transfer delay (particularly winter months). Conclusion: Elective and urgent PCI can be safely and effectively performed in a rural setting with careful planning and support. doi:10.1016/j.hlc.2008.05.214 214 Factors that Influence Patients’ Adherence to Medical Therapy Following Percutaneous Coronary Intervention Mary-Anne Austin ∗, Joshua Casan, Mauro Baldi, Ian Meredith, Sarah Hope MonashHeart, SouthernHealth,Melbourne, Victoria, Australia Background: Evidence based medical therapy followdoi:10.1016/j.hlc.2008.05.213 213 Percutaneous Coronary Interventions in a Rural Australian Hospital Without Surgical Backup: First Year’s Experience Jason Kaplan2,∗, David Amos2, Ruth Arnold2, Michael Ward5, Sidney Lo3, Craig Juergens3, Harry Lowe4, Mark Adams1, Ghasson Charbel 2 1 Royal Prince Alfred Hospital, Sydney, NSW, Australia; 2 Orange Base Hospital, Orange, NSW, Australia; 3 Liverpool Hospital, Sydney, NSW, Australia; 4 Concord Hospital, Sydney, NSW, Australia; 5 Royal North Shore Hospital, Sydney, NSW, Australia Background: Elective and emergent percutaneous coronary intervention (PCI) have been shown to be safely and effectively provided in settings without surgical backup, however there is less experience in centres far remote from surgical centres. We aimed to assess the safety of this practice in a regional setting. Methods:OrangeBaseHospital is a 200bedruralbasehospital 3 h via road and 40min via helicopter from Sydney. Planning was done in close consultation with CSANZ and with the support of three major teaching hospitals. Staff training, patient care protocols and a formalized program for emergent transfer were developed with these centres. Interventionalists were all attached to large centres and agreed to exclude heavily calcified lesions and chronic total occlusions. Cases were selected with the aid of a web based angiogram viewer. ing Percutaneous Coronary Intervention (PCI) includes a range of medications. Data suggests that clinical and socioeconomic factors have a modest affect on adherence to prescribed therapy, whilst an individual’s beliefs pertaining to medication are more predictive. Is this relevant in an Australian tertiary hospital? Methods:Onehundred sixteenpatients from three indication groups (34% primary, 30% semi-urgent, 36% elective) were contacted 6 months following PCI. They described their social and clinical circumstances and answered the Medication Adherence Scale (MAS 0–4), with 86 completing the written Beliefs in Medication Questionnaire (BMQ—beliefs re harm, overuse, necessity and concerns regarding medications). Results: Discharge and 6 months medications were similar between indication groups. Demographic and risk factors were similar between groups, excepting lower rates of known Coronary Heart Disease (CHD) (P= 0.001), hypertension (P< 0.01) and hypercholesteremia (P< 0.05) and greater prevalence of current smoking (P< 0.05) in the primary PCI group. BMQ scores were similar to previously published data for cardiac patients, with no difference in BMQorMAS scores between groups. Thirtythree percentages of patients reported “forgetting to take medication”, and 13% reported “carelessness”. Social circumstances were not associated with MAS or BMQ scores. Patients with previously known CHD described greater belief in the necessity (BMQ) of cardiac medication (P< 0.01). Less adherent patients (MAS≥ 2) expressed greater concern (BMQ) regarding medications (P< 0.01). Conclusions: In this cohort demographic, social and clinical factorshadminimal impact on self-reportedadherence A B S T R A C T S Heart, Lung and Circulation Abstracts S91 2008;17S:S1–S209 rates. Medication beliefs may be amore reliable predictor of adherence. doi:10.1016/j.hlc.2008.05.215
Databáze: OpenAIRE
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