title: Self-reported use of evidence-based medicine and smoking cessation 6 - 9 months after acute coronary syndrome: a single-centre perspective.
abstract: BACKGROUND
  Good evidence exists to support the use of secondary prevention medications (aspirin, statins, beta-blockers and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs)) and smoking cessation in patients after acute coronary syndromes (ACSs). Little is currently known about adherence to medication and smoking behaviour after discharge in South Africa.
  
  
  METHODS
  We conducted a cross-sectional analysis of all patients with a diagnosis of ACS discharged from the Coronary Care Unit at Groote Schuur Hospital, Cape Town, between 15 November 2011 and 15 April 2012. Patients were telephoned 6 - 9 months after discharge and completed a standardised questionnaire detailing current medication use, reasons for non-adherence and smoking status.
  
  
  RESULTS
  Prescribing of secondary prevention medications at discharge was 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 four drugs. At 6 - 9-month follow-up, the proportion using these medications had dropped 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 four drugs, a reduction of 23.5%. Of the 56.0% of patients who were smokers, 31.4% had stopped smoking.
  
  
  CONCLUSIONS
  A significant decline in adherence to recommended therapy 6 - 9 months after discharge and a poor rate of smoking cessation suggest that efforts to educate patients about the importance of long-term adherence need to be improved. Furthermore, more effective interventions than in-hospital reminders about the hazards of smoking are needed to improve smoking cessation.
authors.affiliation: Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa. bpgriffiths@gmail.com.
authors.forename: Bradley
authors.initials: B
authors.lastname: Griffiths
authors.forename: Maia
authors.initials: M
authors.lastname: Lesosky
authors.forename: Mpiko
authors.initials: M
authors.lastname: Ntsekhe
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D055317:Evidence-Based Practice / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010353:Patient Education as Topic; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin