BACKGROUND/RATIONALE:
Acute coronary syndromes, including acute myocardial infarction (MI) are the leading causes of hospitalization for veterans. Recent advances in the treatment of acute MI have led to declines in hospital mortality. Despite this, the risk of recurrent events and mortality after the index MI hospitalization remains substantial in the following year. Non-adherence to proven cardioprotective medications is a potentially modifiable risk factor that contributes to the persistently high risk of adverse outcomes following MI hospitalization. Prior studies have found that adherence to cardioprotective medications declines rapidly in the year following MI hospital discharge with only ~60% of patients still taking statins routinely at 1-year.

As a natural progression from my RCD which identified a high prevalence of medication non-adherence and the negative impact of non-adherence on adverse outcomes, the CDTA will focus on implementing a multi-faceted intervention to improve adherence to cardiovascular medications after ACS hosptial discharge. Addition details and the project objectives are outlined further below. This project was submitted and approved as an IIR in June 2008 with a score of 21.6.

The proposed IIR study will test the hypothesis that a multi-faceted patient-centered adherence intervention targeting veterans following ACS hospitalization improves adherence to cardioprotective medications, achievement of secondary prevention goals (achievement of BP and LDL targets), and is cost-effective. The proposed intervention will be based on the Chronic Care Model and the Medication Adherence Model conceptual frameworks. The intervention will adapt elements of prior successfully adherence interventions, including: collaborative care, patient education, tailoring of medication regimens, and tele-monitoring via interactive voice response (IVR) technology. This study will be tested at 3 sites randomizing 280 patients to intervention versus usual care for 12-months. The specific aims of the project as as follows:

OBJECTIVE(S):
Specific Aims:
1. To determine the effectiveness of a multi-faceted patient-centered adherence intervention versus usual care for improving adherence to cardioprotective medications (i.e., -blockers, statins, clopidogrel, and ACE-inhibitors/ARB) (primary outcome).
2. To determine the effectiveness of a multi-faceted intervention versus usual care for achieving secondary prevention targets for blood pressure and LDL cholesterol.
3. To determine the effectiveness of a multi-faceted intervention versus usual care for reducing the cardiovascular endpoints of MI, revascularization and all-cause mortality.
4. To assess the incremental cost-effectiveness of the multi-faceted patient-centered adherence intervention compared with usual care.

METHODS:
The CDTA will be critical to my continued development into an independent investigator. It will provide the necessary protected time to acquire additional research skills such as the conduct of a multi-center effectiveness clinical trial and formative evaluation of the intervention which is crucial prior to any widespread implementation efforts. The proposed mentors are nationally recognized VA health services researchers and include: 1) Dr. John S. Rumsfeld, nationally recognized VA cardiovascular health services researcher and Clinical Director of IHD-QUERI; 2) Dr. Mary K. Goldstein, Director of Clinical Services Geriatrics Research Education and Clinical Center (GRECC); and 3)Dr. Hayden Bosworth, Associate Director Center for Health Services Research in Primary Care. A CDTA will be crucial in continuing to build on the foundation of knowledge that I have acquired and my progression to an independent VA cardiovascular health services researcher.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
The project is still being conducted.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Magid DJ, Ho PM, Olson KL, Brand DW, Welch LK, Snow KE, Lambert-Kerzner AC, Plomondon ME, Havranek EP. A multimodal blood pressure control intervention in 3 healthcare systems. The American journal of managed care. 2011 Apr 1; 17(4):e96-103. [view]
2. Daugherty SL, Masoudi FA, Ellis JL, Ho PM, Schmittdiel JA, Tavel HM, Selby JV, O'Connor PJ, Margolis KL, Magid DJ. Age-dependent gender differences in hypertension management. Journal of Hypertension. 2011 May 1; 29(5):1005-11. [view]
3. Lopes RD, Peterson ED, Chen AY, Roe MT, Wang TY, Ohman EM, Magid DJ, Ho PM, Wiviott SD, Scirica BM, Alexander KP. Antithrombotic strategy in non-ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention: insights from the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry. JACC. Cardiovascular interventions. 2010 Jun 1; 3(6):669-77. [view]
4. Mays RJ, Casserly IP, Kohrt WM, Ho PM, Hiatt WR, Nehler MR, Regensteiner JG. Assessment of functional status and quality of life in claudication. Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter. 2011 May 1; 53(5):1410-21. [view]
5. Kim MS, Wang TY, Ou FS, Klein AJ, Hudson PA, Messenger JC, Masoudi FA, Rumsfeld JS, Ho PM. Association of prior coronary artery bypass graft surgery with quality of care of patients with non-ST-segment elevation myocardial infarction: a report from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines. American heart journal. 2010 Nov 1; 160(5):951-7. [view]
6. Byrd JB, Zeng C, Tavel HM, Magid DJ, O'Connor PJ, Margolis KL, Selby JV, Ho PM. Combination therapy as initial treatment for newly diagnosed hypertension. American heart journal. 2011 Aug 1; 162(2):340-6. [view]
7. Magid DJ, Shetterly SM, Margolis KL, Tavel HM, O'Connor PJ, Selby JV, Ho PM. Comparative effectiveness of angiotensin-converting enzyme inhibitors versus beta-blockers as second-line therapy for hypertension. Circulation. Cardiovascular quality and outcomes. 2010 Sep 1; 3(5):453-8. [view]
8. Ho PM, Tsai TT, Maddox TM, Powers JD, Carroll NM, Jackevicius C, Go AS, Margolis KL, DeFor TA, Rumsfeld JS, Magid DJ. Delays in filling clopidogrel prescription after hospital discharge and adverse outcomes after drug-eluting stent implantation: implications for transitions of care. Circulation. Cardiovascular quality and outcomes. 2010 May 1; 3(3):261-6. [view]
9. Fitzgerald AA, Powers JD, Ho PM, Maddox TM, Peterson PN, Allen LA, Masoudi FA, Magid DJ, Havranek EP. Impact of medication nonadherence on hospitalizations and mortality in heart failure. Journal of cardiac failure. 2011 Aug 1; 17(8):664-9. [view]
10. Schmittdiel J, Selby JV, Swain B, Daugherty SL, Leong TK, Ho M, Margolis KL, O'Connor P, Magid DJ, Bibbins-Domingo K. Missed opportunities in cardiovascular disease prevention?: low rates of hypertension recognition for women at medicine and obstetrics-gynecology clinics. Hypertension. 2011 Apr 1; 57(4):717-22. [view]
11. Hanratty R, Chonchol M, Havranek EP, Powers JD, Dickinson LM, Ho PM, Magid DJ, Steiner JF. Relationship between blood pressure and incident chronic kidney disease in hypertensive patients. Clinical journal of the American Society of Nephrology : CJASN. 2011 Nov 1; 6(11):2605-11. [view]
12. Welch LK, Olson KL, Snow KE, Pointer L, Lambert-Kerzner A, Havranek EP, Magid DJ, Ho PM. Systolic blood pressure control after participation in a hypertension intervention study. The American journal of managed care. 2012 Jan 18; 17(7):473-8. [view]
13. Arnold SV, Chan PS, Jones PG, Decker C, Buchanan DM, Krumholz HM, Ho PM, Spertus JA, Cardiovascular Outcomes Research Consortium. Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH): design and rationale of a prospective multicenter registry. Circulation. Cardiovascular quality and outcomes. 2011 Jul 1; 4(4):467-76. [view]
14. Kontos MC, Diercks DB, Ho PM, Wang TY, Chen AY, Roe MT. Treatment and outcomes in patients with myocardial infarction treated with acute ß-blocker therapy: results from the American College of Cardiology's NCDR(®). American heart journal. 2011 May 1; 161(5):864-70. [view]
15. Ho PM, Zeng C, Tavel HM, Selby JV, O'Connor PJ, Margolis KL, Magid DJ. Trends in first-line therapy for hypertension in the Cardiovascular Research Network Hypertension Registry, 2002-2007. Archives of internal medicine. 2010 May 24; 170(10):912-3. [view]

Conference Presentations

1. Ho PM. Networking for career development. Paper presented at: VA HSR&D National Meeting; 2008 Feb 1; Baltimore, MD. [view]

DRA: Health Systems, Cardiovascular Disease
DRE: Epidemiology, Treatment - Observational, Prevention, Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: none
MeSH Terms: none