Home Medicines Review following acute coronary syndromes: Preliminary results from a randomised controlled trial

Introduction: Following acute coronary syndromes (ACS) guidelines recommend use of four classes of medication (antiplatelet agents, statins, beta-blockers, and angiotensin-pathway inhibitors) to improve survival and quality of life. Sub-optimal prescribing by clinicians and poor adherence by patients are common and lead to worse outcomes.

Aims: To evaluate the effect of a directed Home Medicines Review (dHMR) performed by trained accredited pharmacists on adherence to guideline-medications at six months following ACS.

Methods: A randomised controlled trial was conducted at two Tasmanian hospitals with all patients admitted with ACS from April 2012 to April 2013 screened for enrolment. An online education package was developed to tailor the HMR towards detecting drug-related problems and improving adherence following ACS, including instructions on how to safely initiate guideline medications if they were not previously prescribed in hospital. Intervention patients received a dHMR two months following discharge. Patient adherence to guideline medications was measured as the primary outcome, using medication refill records at six months. Patients were considered adherent if they had a continuous medication supply of all four guideline medications and an average medication possession ratio of 0.8 or higher.

Results: Three hundred and sixty-seven patients were screened for enrolment; complete data was available for 154 patients (77 per group). The intervention group had a higher rate of non-ST-elevation myocardial infarction as their final discharge diagnosis (39.0% versus 20.7%, p=0.02); there were no other differences between the groups. Thirty-two (41.6%) control and 24 (31.2%) intervention patients were prescribed and adherent to all four classes of medication at six months post-discharge (p=0.18).

Discussion: A dHMR offered to patients two months post-ACS did not appear to influence prescribing and adherence at six months. The overall rate of concordance with prescribing guidelines and patient adherence with medication was low and will be further investigated.