Impact of Pharmacy Counseling on Compliance and Effectiveness of Combination Lipid‐Lowering Therapy in Patients Undergoing Coronary Artery Revascularization: A Randomized, Controlled Trial

Abstract

This randomized, controlled trial evaluated the impact of personalized follow-up on compliance rates in high-risk patients receiving combination lipid-lowering therapy over 2 years. A random sample of 30 patients 7-30 days after cardiac surgery had baseline fasting low-density lipoprotein levels higher than 130 mg/dl. All patients received lovastatin 20 mg/day and colestipol 5 g twice/day. Weekly telephone contact was made with each patient for 12 weeks. Short- and long-term compliance was assessed by pill and packet counts and refill records. Compliance and lipid profile results were significantly better in the intervention group (p<0.05) up to 2 years after the start of therapy than in the control group for all parameters except high-density lipoprotein. However, this effect was not apparent during the first 12 weeks of therapy. Short-term telephone follow-up favorably affected compliance and lipid profile results up to 2 years after start of therapy.

Effects of an enhanced secondary prevention program for patients with heart disease: A prospective randomized trial

“…To illustrate the effectiveness of the program with this well-tolerated class of drugs with clear indications, despite the high prescription rates in the usual care group (approximately twice that in other parts of the country and higher than most other reported rates during the same period [11,[47][48][49][50][51][52]), prescription rates were still somewhat higher in the intervention group. However, the differences between the high rate in the usual care group and the slightly higher rate in the intervention group were not expected to result in a substantial benefit within 19 months compared with what was expected versus placebo (53)(54)(55)(56). This is well illustrated by the results from a recent study (57) that focused on lipid-lowering drugs; a very large number of patients needed to be studied for a longer time to demonstrate a significant but relatively small effect.…”

Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: A systematic review

“…In total, there were 132 140 individuals in the 25 studies, with the smallest study of n=30 17 and the largest study of n=63301. 18 Of the 25 included studies, 11 were randomised controlled trials (RCTs); 17 19-28 1 was a nonrandomised trial, 29 11 were cohort studies, 18 30-39 1 was cross-sectional 25 and 1 was case-control.…”

“…40 Other than 3 studies including upper middle-income countries 24 25 and one including a low middle-income country, 20 21 of the 25 studies (84%) were conducted in countries classified as high-income countries, 9 of which were in the USA. 17 20 24 26 28 and coronary heart disease (from stable CHD, to acute myocardial infarction (AMI), to coronary artery bypass graft (CABG)) (n=14). 17 21 22 and seven studies included only statins.…”

“…17 20 24 26 28 and coronary heart disease (from stable CHD, to acute myocardial infarction (AMI), to coronary artery bypass graft (CABG)) (n=14). 17 21 22 and seven studies included only statins. 17 19 24 33 35 37 40 One study focused on antiplatelet drugs including aspirin.…”

“…In 16 studies, indirect measures of adherence were employed: prescription refill rates (medication possession ratio (MPR), 27 35 proportion of days covered (PDC) 37 and other measures), 17 18 32 Three studies considered persistence and adherence. 23 30 39 Nineteen of 25 included studies were concerned with governance and delivery (table 1).…”