People with acute coronary syndrome (ACS) who undergo an angioplasty procedure and receive a heart stent are prescribed an oral antiplatelet (OAP) therapy and aspirin to help prevent a heart attack, a blood clot in their heart stent (stent thrombosis), or even death.

Yet, a recent survey conducted by Harris Poll found that 52 percent of 275 ACS patients who were currently taking an OAP have missed taking or changed the way they take their prescribed OAP therapy, even though most of them were informed by their doctors of the importance of the therapy to their heart health.

Of these respondents, those under age 65 (194 participants) were much more likely not to follow their OAP therapy regimen as prescribed than older respondents, even though they were more concerned about their health, according to the survey findings.

To address this critical issue, the Preventive Cardiovascular Nurses Association (PCNA), Society for Cardiovascular Angiography and Interventions (SCAI) and Mended Hearts, with support from Daiichi Sankyo, Inc. and Eli Lilly and Company, urge health care professionals to increase their efforts to help ACS patients stick to their prescribed OAP therapy following an angioplasty or cardiac stent procedure.

As the survey found 12 per cent of the total survey respondents said they do not recall being informed by their health care professionals that they faced serious health risks if they did not adhere to their OAP therapy.

"For people who have recently received a heart stent for ACS, changing, skipping or discontinuing OAP therapy increases the risk of serious heart problems or even death," said Jeffrey Cavendish MD, FSCAI, FACC, lead interventional cardiologist for Kaiser Permanente San Diego and director of the cardiac catheterization laboratory at the Scripps Prebys Cardiovascular Institute in La Jolla, California.
To help ACS patients prevent recurrent heart events after an angioplasty procedure, SCAI, PCNA and Mended Hearts are introducing the "After the Stent: Follow Your Action PlanTM" campaign. The campaign aims to mobilise cardiovascular health care professionals to improve ACS patients' knowledge and practices related to OAP adherence.

Annually, about 610,000 people with ACS, which includes heart attack and a type of chest pain called unstable angina (UA), undergo an angioplasty procedure to open a blocked coronary artery. Clinical research shows that up to 16 per cent of these patients stop taking their prescribed OAP therapy in the first 30 days which leaves them more vulnerable to another heart event and increases by 10-fold their risk of death at one year.

"Patients may stop taking their OAP medication for a variety of reasons, such as mistakenly believing their heart condition is 'fixed' or not understanding why or how long they need to take the medication," said Lola Coke, PHD, ACNS-BC, RN-BC, FAHA, FPCNA, associate professor of nursing and cardiovascular clinical nurse specialist at Rush University Medical Center in Chicago, Illinois, and member of the board of directors of PCNA.

"Identifying and correcting these misunderstandings is a first step health care professionals can take to ensure medication adherence. Health care professionals need to make sure that ACS patients and caregivers have the right information and support to follow their medication regimens."

To launch the "After the Stent: Follow Your Action PlanTM" campaign, PCNA and SCAI published a position paper that demonstrates the need for increased attention to OAP medication and highlights practical, research-based solutions to address nonadherence through education, mobilisation, personalisation and teamwork.

Additionally, the groups have developed an OAP nonadherence risk assessment for health care professionals to use with their patients. The assessment includes the 8-question Morisky Medication Adherence Screener, widely used in other disease categories to assess medication adherence, six questions specific to ACS patients who have undergone an angioplasty procedure, and a Conversation Guide to help health care professionals tailor conversations with individual patients based on the risk factors identified in the assessment questionnaires.

The survey also found that of the 296 respondents who visited a health care professional within the 12 months following their angioplasty procedure, 20 per cent said they had questions about their prescribed OAP medication that were not addressed by their health care team. Most likely to have questions were those under age 65 (209 participants).

Additionally, those under age 65 were less aware than those 65 years or older that not taking their OAP medication as prescribed could lead to future cardiac events (74 per cent vs 88 per cent of total respondents respectively). Moreover, only 54 per cent of the total respondents overall said they remember being asked during a follow-up visit with their physician if they filled their OAP medication prescription.

"Coping with a heart event is an overwhelming experience for patients and their families, which makes it especially important that health care professionals take the time to explain what occurred and what needs to happen after the angioplasty procedure to help prevent another heart event," said Donnette Smith, executive vice president of Mended Hearts.

"It is also equally important that patients and caregivers ask their health care team questions if they have concerns or are not clear why or how they should follow their new medication regimen. There are excellent support programmes and tools available to help patients to successfully manage their OAP medication routine. We encourage ACS patients and caregivers to ask for help and support resources.

ACS, which includes heart attack and a type of chest pain called unstable angina (UA), was responsible for the hospitalisation of more than one million people in the United States in 2010. The annual incidence of new heart attacks is estimated to be approximately 620,000 and about 295,000 people will have a recurrent attack. There are two main types of heart attack: non-ST-segment elevation, or NSTEMI, and ST-segment elevation, or STEMI. STEMI heart attacks are often considered more severe as the artery is often fully blocked, preventing blood flow to the heart.



Each year, approximately 610,000 people undergo PCI, which typically includes the implantation of a stent that restores blood flow to blocked arteries in the heart.

The number of UA or NSTEMI ACS patients worldwide who are managed without acute coronary interventions, such as PCI, has ranged from 32 per cent to almost 60 per cent over the last few years.

ACS may result in heart attack, stroke and death, costing Americans more than $150 billion each year. Nearly 60 per cent of the US healthcare costs of ACS are due to re-hospitalisation. Strategies to prevent recurrent heart attacks and re-hospitalisation are important to improve patient outcomes and reduce the cost burden of ACS.

The survey was conducted online by Harris Poll on behalf of Daiichi Sankyo, Inc. and Eli Lilly and Company from  February 13 - April 10, 2014 among 305 adults in the Unites States between the ages of 35 to 74 who underwent an angioplasty procedure with or without a stent within a year of participating in the survey and were prescribed an OAP medication.

At the time of the survey, 214 participants were under 65 years old and 91 were 65 years old or older. Of the total participants, 275 were currently using a prescribed OAP medication and 30 had discontinued their prescribed OAP therapy before a year.