Feature | May 15, 2012

Telephone Support Keeps Patients on Track After Stenting

Adherence to clot-preventing medication significantly better with just four phone calls

May 15, 2012 — Reaching out to patients with a few simple phone calls significantly improves the likelihood they’ll continue to take critically important medication that keeps blood clots from clogging a new stent, according to a study presented today at the SCAI 2012 Scientific Sessions.

The study found that when a nurse checked in by telephone every few months after a stenting procedure, nearly all patients continued to take a combination of clopidogrel (Plavix) and aspirin as prescribed. Adherence to the medication regimen, known as "dual antiplatelet therapy" (DAPT), dropped by about 10 percentage points among a comparison group of patients who received no ongoing telephone follow-up after leaving the hospital.

“We should make every effort to make sure patients do not interrupt dual anti-platelet therapy once they’ve received a drug-eluting stent,” said Stéphane Rinfret, M.D., FSCAI, a clinical and interventional cardiology researcher at the Quebec Heart and Lung Institute. “It’s absolutely crucial. If a patient stops taking clopidogrel or aspirin, it increases the stent thrombosis risk by 100 to 150 times, and that can lead to a heart attack, stroke or death.”

Drug-eluting stents act like scaffolding to prop open an artery after inflation of a tiny balloon clears away a blockage of cholesterol-laden plaque. Over time, these stents release medication that prevents fibrous scar tissue from growing through the stent’s metal mesh walls and obstructing the artery. In addition, patients typically must take dual antiplatelet therapy for a year to prevent platelet blood cells from clumping together on the inner surface of the stent, causing blood clots (stent thrombosis) that can completely block the stent and cut off blood flow to the heart.

For the study, known as the Early discharge After transradial Stenting of Coronary ArterY-IMProving Adherence to Clopidogrel Trial (EASY-IMPACT), Rinfret and his colleagues at the Quebec Hearth and Lung Institute recruited a total of 300 patients who had just been treated with a drug-eluting stent. Patients were randomly assigned to either standard care or special telephone follow-up. Both groups were briefed on the importance of dual antiplatelet therapy before leaving the hospital, but the telephone group also received phone calls from a nurse seven days after stenting and again at one, six and nine months. During the telephone calls, the nurse checked to see whether the patient was taking dual anti-platelet medication as prescribed, inquired about any problems with excess bruising or bleeding and reinforced the importance of continuing therapy.

Researchers also collected pharmacy data for all patients to document whether prescriptions were filled and refilled on schedule, an indicator of whether patients were taking the medication each day as prescribed. They then calculated medication adherence, defined as the proportion of aspirin and clopidogrel pills each patient took over a 12-month period compared to the number they would be expected to have taken.

At the 12-month mark, median adherence to aspirin and clopidogrel were each 99.2 percent in the telephone support group, as compared to 90.2 percent for aspirin and 91.5 percent for clopidogrel in the usual care group (p <0.0001 for both aspirin and clopidogrel).

Researchers also calculated medication persistence, which they defined as having less than a 14-day gap between expected and actual prescription refill dates at any point in the study. They found that for aspirin, 91.2 percent of the telephone group and 72.3 percent of the usual care group remained persistent at six months (p<0.0001), while 87.8 percent and 39 percent, respectively remained persistent at one-year (p<0.0001). For clopidogrel, 90.5 percent of patients in the telephone group and 66.7 percent of patients in the usual care group were still persistent at six months (p<0.0001), while 87.2 percent and 43.1 percent, respectively, were still persistent at one year (p<0.0001).

“As physicians, we should remember that drugs only work in patients who take them,” Rinfret said. “There are ongoing debates about the best antiplatelet agent based on their biological effects, but new approaches to patient management may have an even stronger effect than new drugs on the prevention of heart attack and other complications following implantation of drug-eluting stents.”

BMS-Sanofi provided partial funding for the study. Rinfret reports no other potential conflicts of interest.

For more information: www.scai.org

Related Content

ICDs, non-ischemic cardiomyopathy, University of Alabama at Birmingham study, Circulation
News | Implantable Cardioverter Defibrillators (ICD)| January 18, 2017
A new study published in Circulation has found there is a 23 percent risk in reduction of all-cause mortality in non-...
stress, brain activity, cardiovascular risk, PET-CT, MGH, ISSMS, The Lancet study
News | Cardiac Diagnostics| January 18, 2017
A study led by Massachusetts General Hospital (MGH) and Icahn School of Medicine at Mount Sinai (ISSMS) investigators...
electronic health records, EHR, warfarin therapy management, University of Missouri Health Care, blood thinner
News | Antiplatelet and Anticoagulation Therapies| January 17, 2017
Warfarin is a commonly prescribed blood thinner used to prevent harmful blood clots. However, the drug requires...
ICDs, implantable cardioverter defibrillators, survival rate, elderly patients, JACC study
News | Implantable Cardioverter Defibrillators (ICD)| January 17, 2017
Of patients over age 65 who received an implantable cardioverter-defibrillator (ICD) after surviving sudden cardiac...
University of Utah, Frank Sachse, heart failure, LVAD implantation, left ventricular assist device, biomarker, t-system

Two patients may seem equally sick based upon clinical measures, but differences in their heart physiology could predict who has the potential to recover from heart failure. A study carried out by scientists at the University of Utah finds that patients whose hearts have flattened t-tubules have a decreased chance of showing signs of recovery after implanting a mechanical heart pump. Ordinarily, t-tubules in the heart are long, thin, and rounded. Image courtesy of Frank Sachse.

News | Cardiac Diagnostics| January 17, 2017
Investigators at the University of Utah have identified distinct differences in the hearts of advanced heart failure...
Synergy stent, abluminal polymer DES, bioresorbable polymer DES, bioresorbable polymer metallic stent

The Synergy stent is the first FDA cleared drug-eluting stent to use a bioresorbable polymer drug carrier. When the polymer dissolves after about four months, the devices become a bare metal stent. The technology is supposed to reduce the rate of late stent thrombosis due to vessel inflammation caused by durable polymers.

Feature | Stents Bioresorbable| January 17, 2017 | Dave Fornell
One of the big advancements in drug-eluting stent (DES) technology has been the development of bioresorbable polymers
St. Jude Medical, Amplatzer Amulet LAA Occluder, observational study, TCT 2016
News | Left Atrial Appendage (LAA) Occluders| November 03, 2016
St. Jude Medical Inc. presented favorable results from the largest observational study to date of the company’s...
Medtronic, CoreValve Evolut R TAVR system, U.S. IDE Study, TCT 2016
News | Heart Valve Technology| November 03, 2016
Medtronic plc unveiled new clinical data showing that patients treated with the self-expanding CoreValve Evolut R...
congenital heart patients, cardiac cath lab, anesthesia sedation practices, joint document, SCAI, SPA, CCAS
News | Congenital Heart| November 03, 2016
The Society for Cardiovascular Angiography and Interventions (SCAI), the Society for Pediatric Anesthesia (SPA) and the...
open-heart surgery, PCI, percutaneous coronary intervention, NOBLE trial, left main coronary artery disease, LMCAD, TCT 2016
News | Cardiovascular Surgery| November 03, 2016
Coronary artery bypass (CABG) surgery is the standard treatment for revascularization in patients with left main...
Overlay Init