Sim, HW; Koh, KWL; Poh, SC; Chan, SP; Marchesseau, S; Singh, D; Han, Y; ... Chan, MY; + view all Sim, HW; Koh, KWL; Poh, SC; Chan, SP; Marchesseau, S; Singh, D; Han, Y; Ng, F; Lim, E; Prabath, JF; Lee, CH; Chen, R; Carvalho, L; Tan, SH; Loh, JPY; Tan, JWC; Kuwelker, K; Amanullah, RM; Chin, CT; Yip, JWL; Lee, CY; Gan, J; Lo, CY; Ho, HH; Hausenloy, DJ; Tai, BC; Richards, AM; Chan, MY; - view fewer (2024) Remote intensive management to improve antiplatelet adherence in acute myocardial infarction: a secondary analysis of the randomized controlled IMMACULATE trial. Journal of Thrombosis and Thrombolysis 10.1007/s11239-023-02931-6. (In press).

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Abstract

This study aim to investigate if remote intensive coaching for the first 6 months post-AMI will improve adherence to the twice-a-day antiplatelet medication, ticagrelor. Between July 8, 2015, to March 29, 2019, AMI patients were randomly assigned to remote intensive management (RIM) or standard care (SC). RIM participants underwent 6 months of weekly then two-weekly consultations to review medication side effects and medication adherence coaching by a centralized nurse practitioner team, whereas SC participants received usual cardiologist face-to-face consultations. Adherence to ticagrelor were determined using pill counting and serial platelet reactivity measurements for 12 months. A total of 149 (49.5%) of participants were randomized to RIM and 152 (50.5%) to SC. Adherence to ticagrelor was similar between RIM and SC group at 1 month (94.4 ± 0.7% vs. 93.6±14.7%, p = 0.537), 6 months (91.0±14.6% vs. 90.6±14.8%, p = 0.832) and 12 months (87.4±17.0% vs. 89.8±12.5%, p = 0.688). There was also no significant difference in platelet reactivity between the RIM and SC groups at 1 month (251AU*min [212–328] vs. 267AU*min [208–351], p = 0.399), 6 months (239AU*min [165–308] vs. 235AU*min [171–346], p = 0.610) and 12 months (249AU*min [177–432] vs. 259AU*min [182–360], p = 0.678). Sensitivity analysis did not demonstrate any association of ticagrelor adherence with bleeding events and major adverse cardiovascular events. RIM, comprising 6 months of intensive coaching by nurse practitioners, did not improve adherence to the twice-a-day medication ticagrelor compared with SC among patients with AMI. A gradual decline in ticagrelor adherence over 12 months was observed despite 6 months of intensive coaching.

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