Our mission is to become a worldwide reference for education in the field for all professionals involved in the process to disseminate knowledge & skills of Acute Cardiovascular Care.
Our mission is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging.
Our mission is to promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our mission is to reduce the burden of cardiovascular disease through percutaneous cardiovascular interventions.
Improving the quality of life and reducing sudden cardiac death by limiting the impact of heart rhythm disturbances.
Our mission is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
The ESC Working Groups' goal is to stimulate and disseminate scientific knowledge in different fields of cardiology.
The ESC Councils' goal is to share knowledge among medical professionals practicing in specific cardiology domains.
Dr. Valentin Fuster,
Prof. Salim Yusuf,
By Valentin Fuster, FESC (New York, United States of America)View Discussant report
Open the PresentationWatch the WebcastResources are published as they become available during the congress
List of Authors: VF. Fuster 1, JM. Castellano 1, G. Sanz 1(1) National Centre for Cardiovascular Research (CNIC), Madrid, Spain
RATIONALE Adherence to evidence-based cardiovascular (CV) medications after an acute myocardial infarction (AMI) is low after the first six months. The use of fixed-dose combinations (FDC) have been shown to improve treatment adherence and risk factor control in previous trials with various CV risk profiles. However, no randomized clinical trial has analyzed the impact of a FDC strategy on adherence in post-MI patients including factors affecting patients’ adherence to treatment.METHODSFOCUS (Fixed Dose Combination Drug for Secondary Cardiovascular Prevention) consisted of cross-sectional study (Phase 1) aimed to elucidate factors that interfere with appropriate adherence to CV medications for secondary prevention after an AMI. A 5-country cohort (Argentina, Brazil, Italy, Paraguay, and Spain) of 2118 patients was analyzed. In addition, 695 patients from phase 1 were randomized into a controlled clinical trial (Phase 2) to test the effect of a FDC polypill containing aspirin 100 mg, simvastatin 40mg and ramipril 2.5, 5 or 10 mg on adherence, blood pressure and low density lipoprotein cholesterol (LDL-C), as well as safety and tolerability over a period of 9 months of follow-up. Patients were randomized to either the polypill or the three drugs separately. Primary end-point was adherence to treatment measured the self-report Morisky-Green questionnaire (MAQ) and pill count.RESULTSIn phase 1, overall CV medication adherence defined as a MAQ score ≥16 was 89% and as MAQ score 20 was 45.5%. In a multivariable regression model, the risk of being non-adherent (MAQ<20) was associated with younger age, depression rating scale, being on a complex medication treatment, poorer health insurance coverage, a lower level of social support, with consistent findings across countries. In Phase 2, the FDC group showed improved adherence compared to the group receiving separate medications after 9 months follow up: 63% vs 52% (p=0,006) when using MAQ plus pill count to assess adherence. Adherence was also higher in FDC group when measured by MAQ alone (68% vs. 59%, p=0.049) or pill count alone (92% vs. 82%, p=0.002). No treatment difference was found at follow-up in mean SBP (129.6 vs 128.6 mmHg) nor in mean LDL-C levels (89.9 vs 91.7 mg/dL) nor in serious adverse events (23 [6.6%] vs. 21 [6%]) or death (1, 0.2% in each group).CONCLUSIONS AND RELEVANCE In secondary prevention following an AMI, younger age, being depressed and following a complex drug treatment are associated with a lower medication adherence, while adherence is increased in patients with higher levels of insurance coverage and social support. Compared with the three drugs given separately, the use of a polypill strategy increased self-reported and direct measured medication adherence for secondary prevention following an AMI.
By Salim Yusuf, FESC (Hamilton, Canada)See Presenter abstract
Open the presentationWatch the Webcast
Clinical Trial Update Hot Line: Infarction, interventions and outcome
Our mission: To reduce the burden of cardiovascular disease
© 2017 European Society of Cardiology. All rights reserved