Impact of clinical pharmacist-led behavioural theory-based discharge service to promote medication adherence in patients with acute coronary syndrome: a randomised controlled trial

INTRODUCTION: Medication non-adherence is common in patients with acute coronary syndrome (ACS) and may increase the risk of cardiac readmissions and mortality. AIM: To evaluate the effect of a clinical pharmacist-led, behavioural theory-based discharge service designed to promote medication adherence on 30-day cardiac readmissions (primary outcome) and on clinical, humanistic, and healthcare utilisation outcomes over 360 days in patients with ACS. METHOD: In this single-centre, parallel-group randomised controlled trial, adult patients hospitalised with ACS were assigned by permuted block randomisation (block size 8) to the intervention or control group. The intervention comprised a clinical pharmacist-led, behavioural theory-based discharge service to promote medication adherence. The intervention consisted of medication reconciliation, medication review and patient counselling based on components of the behaviour change technique taxonomy and Health Belief Model. The primary outcome was 30-day hospital readmission for cardiac reasons. Secondary outcomes included all-cause and cardiac readmissions, emergency department visits, all-cause and cardiac mortality, medication adherence, LDL (low-density lipoprotein) target attainment, and quality of life over 360 days. RESULTS: A total of 167 patients were analysed (intervention: n = 80; control: n = 87). The primary outcome occurred in 0/80 (0.0%) in the intervention group versus 5/87 (5.7%) in the control group (risk difference - 5.7%, 95% CI - 12.8 to 2.1%; p >0.050). Over 360 days, the control group had higher adjusted odds of cardiac readmission (aOR 4.4; 95% CI 1.2-16.0; p = 0.027), all-cause readmission (aOR 3.7; 95% CI 1.1-11.7; p = 0.029), and non-adherence at 30 days (aOR 2.4; 95% CI 1.1-5.2; p = 0.028). At 180 days, the control group had lower adjusted odds of LDL target attainment (aOR 0.4; 95% CI 0.2-0.9; p = 0.038). CONCLUSION: This intervention reduced 30-day cardiac readmission, but the effect was not statistically significant. According to findings of secondary outcomes, this behavioural theory-based discharge service at discharge might be effective in reducing healthcare utilisation in the long term and improving the short-term target for medication adherence in patients with acute coronary syndrome. TRIAL REGISTRATION: ClinicalTrials.gov NCT05153707.