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Motivational interviewing to support LDL-C therapeutic goals and lipid-lowering therapy compliance in patients with acute coronary syndromes (IDEAL-LDL) study: rationale and design.

TitleMotivational interviewing to support LDL-C therapeutic goals and lipid-lowering therapy compliance in patients with acute coronary syndromes (IDEAL-LDL) study: rationale and design.
Publication TypeJournal Article
Year of Publication2019
AuthorsBoulmpou, A., Kartas A., Farmakis I., Zafeiropoulos S., Nevras V., Papadimitriou I., Tampaki A., Vlachou A., Lillis L., Koutsakis A., Karvounis H., & Giannakoulas G.
JournalHellenic J Cardiol
Date Published2019 Jul - Aug
KeywordsAcute Coronary Syndrome, Cardiovascular Diseases, Cholesterol, LDL, Dyslipidemias, Greece, Healthy Lifestyle, Hospitalization, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipids, Medication Adherence, Motivational Interviewing, Myocardial Infarction, Myocardial Revascularization, Patient Discharge, Prevalence, Prospective Studies, Secondary Prevention, Stroke

BACKGROUND: Achieving low-density lipoprotein cholesterol (LDL-C) target levels after an acute coronary syndrome (ACS) is of paramount importance, and is often burdened by undertreatment and medication or lifestyle non-adherence issues.
OBJECTIVE: We examined the effect of a patient-centered, physician-led motivational intervention following ACS on relevant secondary prevention aspects.
METHODS-DESIGN: The IDEAL-LDL is a single-center, randomized controlled clinical trial, conducted among patients hospitalized due to an ACS. Following discharge, all patients undergo a baseline assessment of lipid profile. Patients in the intervention group receive an in-person educational session and an informative leaflet, and also undergo two phone-based, motivational interviewing sessions at 1 and 6 months. These interventions emphasize on LDL-C goals, adherence to lipid-lowering medication, and healthy dietary-lifestyle habits, and are not provided to patients in the control group, who receive usual care. At 12 months after each patient's discharge, an in-person interview and lipid profile reassessment are performed. The primary outcomes are the assessment of LDL-C goal achievement (<70 mg/dL or >50% reduction from baseline levels) from baseline to 1 year and changes in medication adherence. Secondary outcomes relate to the incidence of the composite outcome of cardiovascular death, nonfatal myocardial infarction/stroke, need for myocardial revascularization, and recurrent hospitalization during the follow-up period.
DISCUSSION: This paper describes the protocol, design, and rationale for key methodology for an ongoing clinical trial featuring a simple and feasible intervention. Similar adherence efficacy trials have not led to sufficient improvements, and there remains a gap regarding how adherence interventions should be implemented into clinical care.

Alternate JournalHellenic J Cardiol
PubMed ID30352291


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