title: Non-physician health workers for improving adherence to medications and healthy lifestyle following acute coronary syndrome: 24-month follow-up study.
abstract: OBJECTIVE
  To evaluate usefulness of non-physician health workers (NPHW) to improve adherence to medications and lifestyles following acute coronary syndrome (ACS).
  
  
  METHODS
  We randomized 100 patients at hospital discharge following ACS to NPHW intervention (n=50) or standard care (n=50) in an open label study. NPHW was trained for interventions to improve adherence to medicines - antiplatelets, β-blockers, renin-angiotensin system (RAS) blockers and statins and healthy lifestyles. Intervention lasted 12 months with passive follow-up for another 12. Both groups were assessed for adherence using a standardized questionnaire.
  
  
  RESULTS
  ST elevation myocardial infarction (STEMI) was in 49 and non-STEMI in 51, mean age was 59.0±11 years. 57% STEMI were thrombolyzed. On admission majority were physically inactive (71%), consumed unhealthy diets (high fat 77%, high salt 58%, low fiber 57%) and 21% were smokers/tobacco users. Coronary revascularization was performed in 90% (percutaneous intervention 79%, bypass surgery 11%). Drugs at discharge were antiplatelets 100%, β-blockers 71%, RAS blockers 71% and statins 99%. Intervention and control groups had similar characteristics. At 12 and 24 months, respectively, in intervention vs control groups adherence (>80%) was: anti platelets 92.0% vs 77.1% and 83.3% vs 40.9%, β blockers 97.2% vs 90.3% and 84.8% vs 45.0%), RAS blockers 95.1% vs 82.3% and 89.5% vs 46.1%, and statins 94.0% vs 70.8% and 87.5% vs 29.5%; smoking rates were 0.0% vs 12.5% and 4.2% vs 20.5%, regular physical activity 96.0% vs 50.0%, and 37.5% vs 34.1%, and healthy diet score 5.0 vs 3.0, and 4.0 vs 2.0 (p<0.01 for all). Intervention vs standard group at 12 months had significantly lower mean systolic BP, heart rate, body mass index, waist:hip ratio, total cholesterol, triglyceride, and LDL cholesterol (p<0.01).
  
  
  CONCLUSIONS
  NPHW-led educational intervention for 12 months improved adherence to evidence based medicines and healthy lifestyles. Efficacy continued for 24 months with attrition.
authors.affiliation: Department of Pharmacology, SMS Medical College, Jaipur 302004, India; Department of Medicine, Fortis Escorts Hospital, Jaipur 302017, India.
authors.forename: Krishna Kumar
authors.initials: KK
authors.lastname: Sharma
authors.affiliation: Department of Medicine, Fortis Escorts Hospital, Jaipur 302017, India; Department of Medicine, Eternal Heart Care Centre and Research Institute, Jaipur 302020, India. Electronic address: rajeevgg@gmail.com.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Pharmacology, SMS Medical College, Jaipur 302004, India.
authors.forename: Mukul
authors.initials: M
authors.lastname: Mathur
authors.affiliation: Department of Medicine, Fortis Escorts Hospital, Jaipur 302017, India.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Natani
authors.affiliation: Department of Endocrinology, Fortis Escorts Hospital, Jaipur 302017, India.
authors.forename: Sailesh
authors.initials: S
authors.lastname: Lodha
authors.affiliation: Department of Cardiology, Fortis Escorts Hospital, Jaipur 302017, India.
authors.forename: Sanjeeb
authors.initials: S
authors.lastname: Roy
authors.affiliation: Department of Pharmacology, St John's Medical College, Bangalore 560068, India.
authors.forename: Denis
authors.initials: D
authors.lastname: Xavier
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000523:psychology; D003150:Community Health Workers; D005260:Female; D005500:Follow-Up Studies; D000070497:Healthy Lifestyle; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods*; D013997:Time Factors; D016903:Drug Monitoring
keywords: Acute coronary event; Community health worker; Developing countries; Secondary prevention