Adherence to Secondary Prevention Drugs and Influencing Factors After Acute Coronary Syndrome in Patients at a Tertiary Center in Nepal

Adherence to Secondary Prevention Medications and Factors Influencing Adherence, After Acute Coronary Syndrome in Patient Attending a Tertiary Care Centre Of Nepal: A Descriptive Cross-sectional Study

This study aimed to assess adherence to secondary prevention medications among patients in Nepal following an Acute Coronary Syndrome (ACS) event and to identify factors affecting adherence. ACS was a major cause of morbidity and mortality globally and in Nepal, requiring effective secondary prevention to minimize recurrent cardiovascular events. However, adherence to prescribed medications remained low, especially in low- and middle-income countries like Nepal. Poor adherence could lead to increased healthcare burden, worsened patient outcomes, and higher mortality rates. To address this, the study evaluated patients' medication adherence through the MYMEDS questionnaire, a self-reported tool that was positively received for its simplicity and clarity. Conducted at the Manmohan Cardiothoracic Vascular and Transplant Centre in Nepal, the study involved a sample of adult patients who were readmitted or attending follow-ups post-ACS. The research gathered data on patient demographics, socioeconomic factors, clinical characteristics, and self-reported adherence barriers, analyzing these with SPSS to assess correlations with clinical outcomes.

The 12-month project consisted of phases for ethical approvals, data collection, analysis, and report dissemination. By identifying key barriers to adherence, the study aimed to inform targeted interventions that could enhance medication adherence, improve long-term cardiovascular outcomes, and reduce healthcare burdens in Nepal and other similar settings.

Study Overview

• Status: Completed
• Conditions: Adherence; Acute Coronary Syndromes (ACS)
• Intervention / Treatment: Other: My Experience of Taking Medicines (MYMEDS) questionnaire

• Study Type: Observational
• Enrollment (Actual): 109

Contacts and Locations

Study Locations

• Nepal
  • Kathmandu, Nepal, 44600
    • Manmohan Cardiothoracic Vascular and Transplant Centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

A sample of adult patients (age ≥18 years) who have either come to OPD for follow-up or have been readmitted for having cardiac complications months after surviving ACS (including STEMI, NSTEMI, and unstable angina) in Manmohan Cardiothoracic Vascular and Transplant Centre, Nepal was selected via convenience sampling.

Description

Inclusion Criteria:

• Patients diagnosed with ACS, including ST-Elevation Myocardial Infarction (STEMI), Non-ST-Elevation Myocardial Infarction (NSTEMI), or Unstable Angina within the last 12 months
• Patients aged 18 years and older.
• Patients willing to participate and provide informed consent for the study.

Exclusion Criteria:

• Individuals who have not been diagnosed with ACS or those with other acute or chronic conditions that might influence medication adherence unrelated to ACS.
• Patients with cognitive impairments or mental health issues that prevent them from understanding or responding accurately to the study questionnaires.
• Patients with severe chronic conditions (e.g., terminal illness, advanced dementia) that may affect their ability to adhere to medication regimens.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Medication adherence to secondary prevention medications measured using the My Experience of Taking Medicines (MYMEDS) questionnaire	The primary outcome of this study is the level of adherence to prescribed secondary prevention medications among patients with Acute Coronary Syndrome (ACS). Medication adherence will be assessed using the My Experience of Taking Medicines (MYMEDS) questionnaire, a validated self-reported adherence assessment tool developed for patients prescribed secondary prevention medicines after myocardial infarction. Adherence will be specifically evaluated using Section 6 of the MYMEDS questionnaire, which assesses how frequently patients have taken each prescribed secondary prevention medication over the preceding one month. The medications assessed include antiplatelet agents, statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACE inhibitors/ARBs). Responses are recorded on a 5-point Likert scale: All of the time, Nearly all of the time, Most of the time, About half of the time, Less than half of the time. For the purpose of analysis, pat	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient-reported barriers to medication adherence assessed using the My Experience of Taking Medicines (MYMEDS) questionnaire	Secondary outcomes include the identification of patient-reported factors influencing adherence to secondary prevention medications. These factors will be assessed using Sections 2 to 5 of the MYMEDS questionnaire, which evaluate modifiable barriers to medication adherence. These sections assess: Patients' understanding of and satisfaction with prescribed medications Concerns and beliefs regarding potential harms or necessity of medicines Practical difficulties related to medication use (e.g., swallowing pills, opening containers, obtaining refills) Challenges in integrating medications into daily routines, including forgetfulness and inconvenience Responses are measured using a 4-point Likert scale (Strongly agree, Agree, Disagree, Strongly disagree). Higher agreement with barrier-related statements indicates greater perceived barriers to adherence. Results will be summarized as frequencies and proportions for each barrier domain.	1 year
Association between medication adherence and demographic and clinical factors	This outcome will assess the association between medication adherence status (adherent vs non-adherent) and patient demographic characteristics (age, sex, education level, occupation, place of residence, income) as well as clinical factors (type of ACS, comorbidities, and treatment received). This analysis aims to identify population subgroups at higher risk of non-adherence.	1 year

Collaborators and Investigators

• Sponsor: Institute of medicine, Maharagjung medical campus

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2024
• Primary Completion (Actual): August 1, 2025
• Study Completion (Actual): August 1, 2025

Study Registration Dates

• First Submitted: December 4, 2025
• First Submitted That Met QC Criteria: December 4, 2025
• First Posted (Estimated): December 17, 2025

Study Record Updates

• Last Update Posted (Actual): December 24, 2025
• Last Update Submitted That Met QC Criteria: December 17, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Heart Diseases; Myocardial Ischemia; Acute Coronary Syndrome; Health Care Quality, Access, and Evaluation; Investigative Techniques; Epidemiologic Methods; Data Collection; Health Care Evaluation Mechanisms; Quality of Health Care; Public Health; Environment and Public Health; Surveys and Questionnaires
• Other Study ID Numbers: 290 (6-11) E2 081/ 082

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared because the dataset contains sensitive clinical and sociodemographic information from a relatively small, identifiable group of ACS patients at a single tertiary centre, making robust de-identification difficult in the Nepali context. However, the aggregated findings, such as overall adherence pattern and analysis of demographic factors influencing adherence, will be presented in the final study report.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No