Disease awareness, pharmacological adherence, and knowledge on further advanced therapeutic option among medically managed postmyocardial infarction patients: Experience from a Sri Lankan tertiary care cardiac center

Context: Although most of the patients with ischemic heart diseases (IHD) are treated according to the guidelines, adequacy of the knowledge about their treatment is questionable. Aims: The study was aimed to explore the patients' awareness of their disease, state of pharmacological adherence, and the knowledge of their further advance therapeutic options on patients who were subjected to medical management following myocardial infarction (MI). Settings and Design: This study design was a cross-sectional descriptive study. Subjects and Methods: The study was conducted at Cardiology Unit, Teaching Hospital Kandy, Sri Lanka in 2015. Pretested interviewer-administered questionnaire and patients' health records were used to collect the data. All the patients who had MI and currently on medical management were included in the study. Patients who had a percutaneous coronary intervention and coronary artery bypass graft surgeries were excluded from the study. Statistical Analysis Used: Data analysis was performed by SPSS version 19 statistical package. P < 0.05 was considered statistically significant. Results: A total number of 103 patients with a mean age of 58 ± 9 years were included in the study. According to the four-item Morisky Medication Adherence Scale, 51.5% had high adherence to treatments, whereas moderate and low adherences were reported in 42.7% and 5.8%, respectively. The mean number of drugs in polymedicated patients was 7.5 ± 1.6. Only 28% had the awareness about the type of their IHD by pathophysiology in simple terms. Only 33% had discussed the necessity of advanced therapeutic options following their acute coronary event. Conclusions: Suboptimal drug adherence, lack of knowledge about their disease, and inadequacy of health communication are the major issues to be addressed in our post-MI patients

Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

AIMS: Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. METHODS AND RESULTS: A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. CONCLUSIONS: The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks