title: Optimizing prevention and guideline-concordant care in Montenegro.
abstract: BACKGROUND
  Guidelines recommend use of evidence-based medications in patients discharged after an acute coronary syndrome (ACS). Yet the current rates of adherence in many eastern European countries are unknown.
  
  
  OBJECTIVE
  To determine whether 6month outpatient follow-up after ACS is associated with recommended rates of medication adherence in Montenegro.
  
  
  METHODS
  A prospective analysis was conducted in 585 ACS patients confirmed to be alive after ACS at 6month follow-up. The study was undertaken between 2012 and 2015, from 9 International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC) hospitals in the Montenegro. The primary outcome was guideline-concordant care, defined as 100% compliance with 5 medications: aspirin, clopidogrel, beta-blockers, and statins in ACS patients, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers [ACEI/ARB] for the subset of patients with left ventricular systolic dysfunction, as assessed by an ejection fraction less than 40% at discharge. In addition to the composite end point, the achievement of each single treatment measure was analyzed. Multivariate predictors of long-term medication adherence were also identified.
  
  
  RESULTS
  Guideline-concordant care (GCC) at discharge increased from 2012 to 2015 (adjusted OR for increase 1.51; CI 0.88-2.52). GCC over 6months was adhered in 73% of patients. In patients who did not achieve GCC, adherence was persistently high with 92.3% for aspirin, 91.3% for statins and 72% for ACE-inhibitors or angiotensin-receptor blockers (ARBs). Adherence was lower for clopidogrel (57.7%) and beta-blockers (64.4%). After adjusting for demographic and clinical differences, in-hospital referral to PCI and ST segment elevation myocardial infarction (STEMI) were associated with greater medication adherence at 6month follow-up.
  
  
  CONCLUSIONS
  In Montenegro, long-term adherence to evidence-based medication after ACS is high. Adherence to guideline-recommended therapies increased over time with participation to the ISACS-TC. The lower achievement of GCC in patients treated medically and in those with non-ST-segment elevation ACS needs particular attention.
authors.affiliation: Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro. Electronic address: cicacg@t-com.me.
authors.forename: Božidarka
authors.initials: B
authors.lastname: Knežević
authors.affiliation: Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro.
authors.forename: Ljilja
authors.initials: L
authors.lastname: Musić
authors.affiliation: Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro.
authors.forename: Goran
authors.initials: G
authors.lastname: Batrićević
authors.affiliation: Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro.
authors.forename: Aneta
authors.initials: A
authors.lastname: Bošković
authors.affiliation: Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro.
authors.forename: Nebojša
authors.initials: N
authors.lastname: Bulatović
authors.affiliation: Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro.
authors.forename: Ana
authors.initials: A
authors.lastname: Nenezić
authors.affiliation: Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro.
authors.forename: Jelena
authors.initials: J
authors.lastname: Vujović
authors.affiliation: Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro.
authors.forename: Milovan
authors.initials: M
authors.lastname: Kalezić
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D000077144:Clopidogrel; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D054548:Montenegro; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016903:Drug Monitoring
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Acute coronary syndromes; Adherence; Guideline-concordant care Montenegro; Therapy