To assess the effectiveness of DAPT adherence on all-cause mortality among post-PCI patients and explore the potential determinants of DAPT adherence

Article ID: 4740

Keywords: Dual antiplatelet therapy, acute coronary syndrome, per-cutaneous coronary intervention, trajectories

Abstract

Background: Adherence to dual antiplatelet therapy (DAPT) is critical
for preventing adverse outcomes in acute coronary syndrome (ACS) patients
following percutaneous coronary intervention (PCI). Despite its importance, adherence rates decline significantly over time, and limited research has explored
the dynamic trajectories of adherence and their predictors. Objective: To analyze
the dynamic trajectories of DAPT adherence over 12 months in ACS patients
post-PCI, identify predictors of adherence, and evaluate the impact of a digital
post-discharge management platform. Methods: This longitudinal observational
study included 100 ACS patients who underwent PCI. DAPT adherence was
assessed at 1, 3, 6, 9, and 12 months post-discharge using a digital management
platform. A latent variable growth model identified adherence trajectories, and
logistic regression analyzed predictors. Clinical outcomes were compared between adherence groups. Results: The study showed that the Adherence declined
from 88% at 1 month to 60% at 12 months. Three adherence trajectories were
identified: independently: 55% were consistently adherent to the diet regimen,
30% were slow deteriorators, and the remaining 15% were fast deteriorators.
Multivariate logistic regression examination of perceived barriers of medication
adherence revealed that smoking (OR = 2.18; p = 0.001), anxiety (OR = 3.41; p =
0.000), low family support (OR = 0.43; p = 0.000) and age > 65 years (OR = 1.12;
p = 0.03) were significantly related and predictive of Apart from lack of knowledge, forgetfulness (40%), side effects (25%), and costs (20%) caused forgetfulness. In those patients, non-adherence was linked with significantly higher level
of major adverse cardiac events (22.5% vs. 6%; p = 0.012) and re-hospitalization
(25% vs 。9%; p = 0.026). The platform improved adherence at 6 months (76%
vs 。70%; p = 0.04), patient satisfaction (92% vs 。78%; p < 0.01), and follow-up
completion rates (95% vs. 85%; p = 0.02).Conclu-sion: Patients following an
ACS and who have undergone PCI adhere poorly to DAPT with patients
differing in demographic, psychological and social predic-tors exhibiting
different trends over time. What was noted was the patient utilityand efficacy of using a digital post-discharge management system in streamlining
practice. Taken together, these results reveal the necessity of developing individualised strategies for the promotion of medication compliance and its objectives.