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

NCT07288502 | Completed DMC

• 1 other identifier: 290 (6-11) E2 081/ 082
• Study Type: observational
• Target: 109
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Acute Coronary Syndromes (ACS); Adherence

Outcome Measures

Primary Outcomes (1)

• 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 Outcomes (2)

• Patient-reported barriers to medication adherence assessed using the My Experience of Taking Medicines (MYMEDS) questionnaire

  1 year

• Association between medication adherence and demographic and clinical factors

  1 year

Interventions

My Experience of Taking Medicines (MYMEDS) questionnaire OTHER

This study does not involve a clinical or therapeutic intervention. Instead, it employs an assessment-based approach to evaluate medication adherence among post-Acute Coronary Syndrome (ACS) patients. The core instrument is the My Experience of Taking Medicines (MYMEDS) questionnaire, a validated, self-reported tool specifically designed to identify modifiable barriers to adherence in individuals prescribed secondary prevention medications. The questionnaire is structured into six sections that systematically explore patients' current medication use, their understanding and satisfaction with their prescribed regimen, specific concerns about the medicines, practical challenges in medication administration, difficulties in integrating medications into daily routines, and a detailed assessment of adherence to each individual secondary prevention drug over the preceding month. Utilizing primarily Likert-scale responses, the tool provides a nuanced understanding of adherence behaviors and t

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• 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.

You may qualify if:

• 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.

You may not qualify if:

• 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.

Sponsors & Collaborators

• Institute of medicine, Maharagjung medical campus: lead

Study Sites (1)

Manmohan Cardiothoracic Vascular and Transplant Centre

Kathmandu, 44600, Nepal

Location

MeSH Terms

Conditions

Acute Coronary Syndrome

Interventions

Surveys and Questionnaires

Condition Hierarchy (Ancestors)

Myocardial Ischemia; Heart Diseases; Cardiovascular Diseases; Vascular Diseases

Intervention Hierarchy (Ancestors)

Data Collection; Epidemiologic Methods; Investigative Techniques; Health Care Evaluation Mechanisms; Quality of Health Care; Health Care Quality, Access, and Evaluation; Public Health; Environment and Public Health

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: December 4, 2025
• First Posted: December 17, 2025
• Study Start: August 1, 2024
• Primary Completion: August 1, 2025
• Study Completion: August 1, 2025
• Last Updated: December 24, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share

Locations

NE (1)