PMID- 27931556
OWN - NLM
STAT- MEDLINE
DCOM- 20170524
LR  - 20181113
IS  - 2213-3763 (Electronic)
IS  - 0019-4832 (Print)
IS  - 0019-4832 (Linking)
VI  - 68
IP  - 6
DP  - 2016 Nov-Dec
TI  - Non-physician health workers for improving adherence to medications and healthy 
      lifestyle following acute coronary syndrome: 24-month follow-up study.
PG  - 832-840
LID - S0019-4832(16)30006-2 [pii]
LID - 10.1016/j.ihj.2016.03.027 [doi]
AB  - OBJECTIVE: To evaluate usefulness of non-physician health workers (NPHW) to 
      improve adherence to medications and lifestyles following acute coronary syndrome 
      (ACS). METHODS: We randomized 100 patients at hospital discharge following ACS to 
      NPHW intervention (n=50) or standard care (n=50) in an open label study. NPHW was 
      trained for interventions to improve adherence to medicines - antiplatelets, 
      beta-blockers, renin-angiotensin system (RAS) blockers and statins and healthy 
      lifestyles. Intervention lasted 12 months with passive follow-up for another 12. 
      Both groups were assessed for adherence using a standardized questionnaire. 
      RESULTS: ST elevation myocardial infarction (STEMI) was in 49 and non-STEMI in 
      51, mean age was 59.0+/-11 years. 57% STEMI were thrombolyzed. On admission 
      majority were physically inactive (71%), consumed unhealthy diets (high fat 77%, 
      high salt 58%, low fiber 57%) and 21% were smokers/tobacco users. Coronary 
      revascularization was performed in 90% (percutaneous intervention 79%, bypass 
      surgery 11%). Drugs at discharge were antiplatelets 100%, beta-blockers 71%, RAS 
      blockers 71% and statins 99%. Intervention and control groups had similar 
      characteristics. At 12 and 24 months, respectively, in intervention vs control 
      groups adherence (>80%) was: anti platelets 92.0% vs 77.1% and 83.3% vs 40.9%, beta 
      blockers 97.2% vs 90.3% and 84.8% vs 45.0%), RAS blockers 95.1% vs 82.3% and 
      89.5% vs 46.1%, and statins 94.0% vs 70.8% and 87.5% vs 29.5%; smoking rates were 
      0.0% vs 12.5% and 4.2% vs 20.5%, regular physical activity 96.0% vs 50.0%, and 
      37.5% vs 34.1%, and healthy diet score 5.0 vs 3.0, and 4.0 vs 2.0 (p<0.01 for 
      all). Intervention vs standard group at 12 months had significantly lower mean 
      systolic BP, heart rate, body mass index, waist:hip ratio, total cholesterol, 
      triglyceride, and LDL cholesterol (p<0.01). CONCLUSIONS: NPHW-led educational 
      intervention for 12 months improved adherence to evidence based medicines and 
      healthy lifestyles. Efficacy continued for 24 months with attrition.
CI  - Copyright A(c) 2016 Cardiological Society of India. Published by Elsevier B.V. All 
      rights reserved.
FAU - Sharma, Krishna Kumar
AU  - Sharma KK
AD  - Department of Pharmacology, SMS Medical College, Jaipur 302004, India; Department 
      of Medicine, Fortis Escorts Hospital, Jaipur 302017, India.
FAU - Gupta, Rajeev
AU  - Gupta R
AD  - Department of Medicine, Fortis Escorts Hospital, Jaipur 302017, India; Department 
      of Medicine, Eternal Heart Care Centre and Research Institute, Jaipur 302020, 
      India. Electronic address: rajeevgg@gmail.com.
FAU - Mathur, Mukul
AU  - Mathur M
AD  - Department of Pharmacology, SMS Medical College, Jaipur 302004, India.
FAU - Natani, Vishnu
AU  - Natani V
AD  - Department of Medicine, Fortis Escorts Hospital, Jaipur 302017, India.
FAU - Lodha, Sailesh
AU  - Lodha S
AD  - Department of Endocrinology, Fortis Escorts Hospital, Jaipur 302017, India.
FAU - Roy, Sanjeeb
AU  - Roy S
AD  - Department of Cardiology, Fortis Escorts Hospital, Jaipur 302017, India.
FAU - Xavier, Denis
AU  - Xavier D
AD  - Department of Pharmacology, St John's Medical College, Bangalore 560068, India.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20160407
PL  - India
TA  - Indian Heart J
JT  - Indian heart journal
JID - 0374675
SB  - IM
MH  - Acute Coronary Syndrome/*drug therapy/psychology
MH  - *Community Health Workers
MH  - Female
MH  - Follow-Up Studies
MH  - *Healthy Lifestyle
MH  - Humans
MH  - Male
MH  - Medication Adherence/*statistics & numerical data
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Secondary Prevention/*methods
MH  - Time Factors
PMC - PMC5143810
OTO - NOTNLM
OT  - Acute coronary event
OT  - Community health worker
OT  - Developing countries
OT  - Secondary prevention
EDAT- 2016/12/10 06:00
MHDA- 2017/05/26 06:00
PMCR- 2017/11/01
CRDT- 2016/12/10 06:00
PHST- 2015/10/18 00:00 [received]
PHST- 2016/01/15 00:00 [revised]
PHST- 2016/03/22 00:00 [accepted]
PHST- 2016/12/10 06:00 [entrez]
PHST- 2016/12/10 06:00 [pubmed]
PHST- 2017/05/26 06:00 [medline]
PHST- 2017/11/01 00:00 [pmc-release]
AID - S0019-4832(16)30006-2 [pii]
AID - 10.1016/j.ihj.2016.03.027 [doi]
PST - ppublish
SO  - Indian Heart J. 2016 Nov-Dec;68(6):832-840. doi: 10.1016/j.ihj.2016.03.027. Epub 
      2016 Apr 7.