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Improving Adherence to Ticagrelor in Patients After Acute Coronary Syndrome: Results from the Progress Trial

Author(s):

Mario Crisci, Felice Gragnano, Marco Di Maio, Vincenzo Diana, Elisabetta Moscarella, Ivana Pariggiano, Dario Di Maio, Claudia Concilio, Vittorio Taglialatela, Fabio Fimiani, Arturo Cesaro, Plinio Lorenzo Cirillo and Paolo Calabrò*   Pages 1 - 7 ( 7 )

Abstract:


Background: Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor is recommended for at least 12 months in patients after an acute coronary syndrome (ACS). However, its underuse and premature discontinuation is common in clinical practice. We aimed to investigate the impact of a dedicated follow-up strategy with clinical visits and counseling on adherence levels to ticagrelor in patients after ACS.

Methods: The PROGRESS is a prospective, randomized trial enrolling 400 ACS patients treated with ticagrelor. Patients were randomized to be followed-up in a dedicated outpatient clinic (In-person follow-up group, [IP-FU], n=200), or with scheduled for phone interviews only (Telephone follow-up group [TEL-FU], n=200), to assess ticagrelor adherence and related complications. DAPT disruption was defined as an interruption of the administration of the drug due to complications or other reasons of noncompliance, and divided according to the duration into short (1-5 days), temporary (6-30 days), and permanent (≥30 days) disruption. The primary endpoint was the rate of DAPT disruption at 1-year follow-up.

Results: The rate of ticagrelor disruption at 1-year follow-up was higher in the TEL-FU group than in the IN-FU group (19.6 vs. 5.5%; p<0.0001). IN-FU group reported a significantly lower rate of short (3.0 vs 8.5%; p=0.012) and permanent (2.0 vs 9.6%; p=0.012) disruption than TEL-FU group. The rate of major bleeding did not differ significantly between the two groups (p=0.450).

Conclusion: The PROGRESS trial showed a net reduction in DAPT disruption in patients followed-up with clinical (in-person) follow-up visits in a dedicated outpatient clinic compared with those scheduled for phone interviews only.

Keywords:

ticagrelor, adherence, acute coronary syndrome, bleeding, disruption, dual antiplatelet therapy

Affiliation:

Department of Cardiology, Division of Interventional Cardiology, A.O.R.N. dei Colli - Monaldi Hospital, Naples, Division of Clinical Cardiology, A.O.R.N. “Sant`Anna e San Sebastiano”, Caserta, Italy. Department of Translational Medical Sciences, University of Campania , Division of Clinical Cardiology, A.O.R.N. “Sant`Anna e San Sebastiano”, Caserta, Italy. Department of Translational Medical Sciences, University of Campania , Division of Clinical Cardiology, A.O.R.N. “Sant`Anna e San Sebastiano”, Caserta, Italy. Department of Translational Medical Sciences, University of Campania , Division of Clinical Cardiology, A.O.R.N. “Sant`Anna e San Sebastiano”, Caserta, Italy. Department of Translational Medical Sciences, University of Campania , Division of Clinical Cardiology, A.O.R.N. “Sant`Anna e San Sebastiano”, Caserta, Italy. Department of Translational Medical Sciences, University of Campania , Division of Clinical Cardiology, A.O.R.N. “Sant`Anna e San Sebastiano”, Caserta, Italy. Department of Translational Medical Sciences, University of Campania , Division of Clinical Cardiology, A.O.R.N. “Sant`Anna e San Sebastiano”, Caserta, Italy. Department of Translational Medical Sciences, University of Campania , Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Division of Clinical Cardiology, A.O.R.N. “Sant`Anna e San Sebastiano”, Caserta, Italy. Department of Translational Medical Sciences, University of Campania , Division of Clinical Cardiology, A.O.R.N. “Sant`Anna e San Sebastiano”, Caserta, Italy. Department of Translational Medical Sciences, University of Campania , Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Division of Clinical Cardiology, A.O.R.N. “Sant`Anna e San Sebastiano”, Caserta, Italy. Department of Translational Medical Sciences, University of Campania



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