Medications adherence post-primary percutaneous coronary intervention in acute myocardial infarction: A population-based cohort study.

WHAT IS KNOWN AND OBJECTIVE: The use of medications for secondary prevention is the cornerstone in the treatment of coronary artery disease (CAD). However, adherence to these medications is still suboptimal worldwide. This retrospective observational study aimed to assess the adherence to post-percutaneous coronary intervention (PCI) medications, along with predictors of non-adherence. METHODS: We conducted a retrospective observational cohort study to assess the adherence to post-PCI medications by determining the rate of prescription refills for 12 months after discharge among STEMI patients, as well as predictors of non-adherence. Adherence was assessed by medication availability 80% of the time monitored by the prescription refills rate for 1 year post-discharge. RESULTS AND DISCUSSION: A total of 1334 patients who presented with STEMI and underwent primary PCI were included in our retrospective analysis. The majority of patients included were male (96%) with a mean age of 51 ± 10.2 years. The overall adherence rate for all medications was only 28.4%, with an individual adherence rate of 50.5% for aspirin, 49.9% for P2 Y12 inhibitors, 48.1% for statins, 39.6% for beta-blockers and 42.9% for angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB). Factors that increased the likelihood of non-adherence were prolonged hospital length of stay and getting the medications with charge (aOR = 1.94, 95% CI 1.1-3.3; p-value = 0.017, aOR = 1.87, 95% CI 1.1-3.3; p-value = 0.029, respectively), while having a regular follow-up after discharge and attending the first clinic appointment were significantly associated with decreased likelihood of non-adherence (aOR = 0.01, 95% CI 0.004-0.04; p-value < 0.001, aOR = 0.06, 95% CI 0.03-0.1; p-value < 0.001, respectively). WHAT IS NEW AND CONCLUSION: The adherence rate to post-PCI medications among patients with STEMI was relatively low; however, attending the first outpatient clinic appointment and having a regular follow-up reduced the likelihood of non-adherence.

Isolation Unit: A New Way to Practice at Heart Hospital, Qatar during the Corona Virus -2019 Pandemic.

BACKGROUND: The novel coronavirus disease-2019 (COVID-19) spread rapidly around the world and was declared as the second pandemic of the 21st century. The first case was detected in Qatar on February 29, 2020. In order to protect patients and staff in Heart Hospital, the only tertiary cardiac center in Qatar, new measures were implemented to reduce the spread of infection in our hospital. METHODOLOGY: A 13-bed high dependency isolation unit was allocated to receive cardiac patients with appreciate infection control measures. Another isolation unit was also established in coronary care unit for critical patients. All patients admitted to Heart Hospital were tested for COVID-19 on admission. Patients were transferred out of isolation, if result was negative. Patients with positive results were either transferred to a COVID facility before or after planned cardiac procedure depending on their cardiovascular disease risk. RESULTS: Six hundred and seven patients were admitted to both the isolation units, most of them were men (89%). Forty-four percent were diagnosed with ST elevation myocardial infarction, 22% were non-STEMI or unstable angina, 17% were decompensated heart failure, 7% were elective cases for coronary angiography or electrophysiology procedures, 8% for other diagnosis, and 1% for both cardiac arrest and post cardiac surgery. 85.2% of the patients admitted to isolation units were tested negative and transferred to normal wards to complete their treatment. Eighty percent of the patients tested positive or reactive for COVID-19 had epidemiological risk, 8.4% had suggestive symptoms, and 11.6% had abnormal chest X-ray. CONCLUSION: This study demonstrated the importance of the isolation unit with infection control measures in controlling the transmission of COVID-19 in a hospital setting such as the Heart Hospital. Epidemiological risk factors including recent travel, close contact with suspected or confirmed cases within 14 days or less, living in shared accommodation or living in lockdown area were the main risk factors for spreading COVID-19 infection which can be managed by minimizing social activities.