Includes bibliographical references.Study Rationale: Good evidence exists to support the use of secondary prevention medications (aspirin, HMG-CoA reductase inhibitors [statins], beta-blockers and angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers [ARBs]) and smoking cessation in patients after acute coronary syndromes. At present, little is known about adherence to medication and smoking behaviour after discharge in South Africa. This information is essential to optimising both in-patient care and post-discharge planning of these patients. Methods: We conducted a cross sectional analysis of all patients discharged from the Groote Schuur Hospital Coronary Care Unit with a diagnosis of acute coronary syndrome between 15 November 2011 and 15 April 2012. A follow up telephone call was performed 6 to 9 months after discharge, and a standardized questionnaire completed detailing current medication use, reasons for non-adherence, and smoking status at time of the interview. Results: Prescribing of secondary prevention medications at discharge was found to be high (aspirin 94.5%, statins 95.7%, beta blockers 85.4%, ACEIs/ARBs 85.9%), and 70.7% of patients were discharged on a combination of all 4 drugs. At 6 to 9 month follow-up, the proportion of patients using these medications had reduced by 8.9% for aspirin, 10.1% for statins, 6.2% for beta-blockers and 17.9% for ACEIs/ARBs. Only 47.2% remained on all 4 drugs, a reduction of 23.5%. Of the 56% of patients who were smokers on admission to hospital, 31% had stopped smoking at the time of interview. Conclusions: Despite high rates of pre-discharge prescription of recommended therapy following admissions for acute coronary syndromes, we observed a significant decline in adherence rates 6 to 9 months post discharge and a poor rate of smoking cessation. An exploration of possible reasons for these findings suggests that efforts to educate patients about the importance of long-term adherence need to be improved. Furthermore, more effective interventions are needed to improve smoking cessation than in-hospital reminders about the hazards of smokin
