El-Toukhy Hassan, Omar Abdullah, Abou Samra Manal
Dr. Soliman Fakeeh Hospital, Falastin, Al-Hamra'a, Jeddah 21461, Saudi Arabia.
Dallah Hospital, An Nakhil, Riyadh 12381, Saudi Arabia.
J Saudi Heart Assoc. 2017 Oct;29(4):252-258. doi: 10.1016/j.jsha.2017.02.003. Epub 2017 Mar 8.
To assess the effect of acute coronary syndrome (ACS) patients' education on their adherence to dual antiplatelet therapy (DAPT) and on lifestyle modifications.
Patients who were prescribed acetyl salicylic acid and clopidogrel DAPT within 15 days of having an ACS event were enrolled in this study. Patients were randomized into two arms: the first arm received the study intervention, which consisted of education on coronary artery disease and the importance of sustained platelet inhibition, whereas the second arm was the control group. Both arms received education on lifestyle modifications. Patients completed six visits over 1 year. At each visit, pill count was used to assess adherence to DAPT, data on lifestyle modifications were collected, and changes in weight and waist circumference were recorded. Cardiovascular risk factors were recorded at baseline and the occurrence of new events was monitored throughout the study.
There were 153 patients in Arm 1 and 168 in Arm 2. At Month 6, 99.3% of patients in Arm 1 were adherent compared with 94.4% in Arm 2 ( = 0.016). At Month 12, 303 (94.4%) patients from the overall population were adherent to DAPT and there was no significant difference between the two arms ( = 0.443). In addition, no statistically significant difference was found in mean change in weight (3 kg vs. 2 kg, = 0.064) or mean change in waist circumference (3.5 cm vs. 2.6 cm, = 0.071) between the two arms. There was a significant decrease in the percentage of smokers ( < 0.001) and a significant increase in the percentage of physically active patients ( < 0.001) within each arm between baseline and Month 12, but the percent change in smokers ( = 1.72, = 0.085) and percent change in physically active patients ( = 0.76, = 0.447) between the two arms were not significantly different. Fourteen myocardial infarctions and two strokes occurred throughout the study period.
Patient education on DAPT showed short-term effect on adherence to treatment. More effective education methods should be developed to improve long-term DAPT adherence.
评估急性冠状动脉综合征（ACS）患者教育对其双联抗血小板治疗（DAPT）依从性及生活方式改变的影响。
在发生ACS事件后15天内开始接受阿司匹林和氯吡格雷双联抗血小板治疗的患者纳入本研究。患者被随机分为两组：第一组接受研究干预，包括关于冠状动脉疾病及持续血小板抑制重要性的教育，而第二组为对照组。两组均接受生活方式改变方面的教育。患者在1年内完成6次访视。每次访视时，通过清点药片数量评估DAPT依从性，收集生活方式改变的数据，并记录体重和腰围的变化。在基线时记录心血管危险因素，并在整个研究过程中监测新事件的发生情况。
第一组有153例患者，第二组有168例患者。在第6个月时，第一组99.3%的患者依从治疗，而第二组为94.4%（P = 0.016）。在第12个月时，总体人群中有303例（94.4%）患者依从DAPT，两组之间无显著差异（P = 0.443）。此外，两组之间体重的平均变化（3千克 vs. 2千克，P = 0.064）或腰围的平均变化（3.5厘米 vs. 2.6厘米，P = 0.071）均未发现有统计学意义的差异。在基线至第12个月期间，每组内吸烟者的百分比显著下降（P < 0.001），身体活动患者的百分比显著增加（P < 0.001），但两组之间吸烟者的百分比变化（P = 1.72，P = 0.085）和身体活动患者的百分比变化（P = 0.76，P = 0.447）无显著差异。在整个研究期间发生了14例心肌梗死和2例中风。
对患者进行DAPT教育对治疗依从性有短期影响。应开发更有效的教育方法以提高长期DAPT依从性。
