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Background: Medication adherence to guideline-recommended therapy is important and associated with a lower rate of death and major adverse cardiovascular events (MACE) among patients with acute coronary syndrome (ACS).Objective: This retrospective study aimed to evaluate medication adherence in four classes of guideline-recommended medicines (antiplatelets, ACEIs/ARBs, beta-blockers, and statins) among patients discharged with ACS and to assess the association between patients' adherence to each medication and the occurrence of MACE including all causes of death, myocardial infarction, unstable angina, heart failure, stroke, atrial fibrillation or coronary revascularization.Methods: The electronic medical records of patients with ACS admitted at a tertiary teaching hospital in northern Thailand between January 1, 2010 and December 31, 2015 were reviewed. Medication adherence was evaluated from a hospital database of prescription refills using the medication gap technique with ≥90% as a cut-off for full adherence and <90% as partial adherence.Results: Of 256 patients, the mean age was 65.9 (±13.0) years. The median percentage of medication adherence in the dual antiplatelet group, ACEI/ARB group, beta-blocker group, and statin group were 94.7, 93.6, 93.1, and 93.1%, respectively. Sixty-two patients (24.2%) experienced MACE after a median follow-up of 1.5 years. Patients with ≥90% adherence of beta-blockers had a significantly lower risk of MACE than those with <90% adherence: HR = 0.47, 95% Cl, 0.26-0.87, p = 0.016, adjusted with potential confounders. No other significant associations were observed.Conclusions: Medication adherence of each medication was above 90%. ACS patients with at least 90% adherence to beta-blockers had a lower risk of MACE than those having less than 90% adherence, but no other significant associations were found for other medications. [ABSTRACT FROM AUTHOR]

Background: Several medications are likely to be potentially inappropriate medications for patients with heart failure (PIMHF) as they may worsen heart failure (HF). A screening tool inclusive of PIMHF is lacking.Objective: To develop an extensive list of PIMHF for HF patients.Methods: A list of PIMHF was developed using reviews of recent HF guidelines and literature and validated through a survey study of HF experts using a modified Delphi technique. The study participants were Thai HF experts with ≥ 5 years of practice experience in Thailand. To create an initial list of PIMHF, medications likely to be PIMHF were gathered from both HF guidelines and HF-related explicit criteria. A 3-round Delphi survey was conducted for 9 months, from January 1, 2019 to September 30, 2019. In the first round, medication items that ≥ 60% of the participants rated as "not PIMHF" were excluded. The two subsequent rounds were conducted to measure an agreement on PIMHF. To reach consensus, medication items in the PIMHF list had to meet the following pre-determined criteria: convergence (median ≥ 3.5 and interquartile range ≤ 1.5) and stability (marginal changes of medians between round 2 and round 3 < 15%).Results: Seventeen eligible HF experts, including 10 cardiologists, 3 hospital pharmacists and 4 academic pharmacists, participated in the study. The initial list of PIMHF consisted of 100 medication items. From round 1, 8 medication items were excluded from the initial list. Thus, 92 medication items were considered in the second and the third round, respectively. After 3 surveys, 47 medication items reached the consensus and agreed as PIMHF.Conclusion: This Delphi survey on opinion about PIMHF among an HF expert panel produced a list of 47 medication items as PIMHF which may be used as a screening tool for PIMHF in Thai HF patients. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to determine the effectiveness of music therapy (MT) with imbedded 10 Hz binaural beats in combination with standard treatment in comparison to standard treatment alone in patients diagnosed with major depressive disorder (MDD).Methods: This study was a randomized controlled trial enrolling 18 MDD adult patients aged ≥20 years old with mild to moderate levels of acute phase depression. The intervention group received MT along with standard treatment, while the control group received only standard treatment. 10-Hz binaural beats were embedded into soothing music. The participants listened to the MT via stereo headphones for 20 min at the clinic and were instructed to continue listening to the track at home at least 3 times/week. The primary outcome was depression score using patient health questionnaire depression screening (PHQ-9). The secondary outcomes were quality of life, measured by the Euro Quality of Life Five-Dimension (EQ-5D) rating, and medications adherence, measured by the medication adherence rating scale (MARS). The outcomes were measured at week 0, week 4, and week 8.Results: At baseline, the primary outcome of PHQ-9 did not differ between the MT group and the control group (13.3 ± 4.4; 13.9 ± 3.37; p-value = 0.77). After a follow-up of 4 and 8 weeks, the PHQ-9 in the MT group was lower than the control group by 1.50 (95 % confidence interval: -4.46 to 1.46). However, this difference was not significant, with p-value = 0.32. As for the secondary outcome, there were no significant differences in terms of EQ-5D and MARS.Conclusions: This study concluded that MDD patients who received 10-Hz binaural beat imbedded MT combined with standard treatment had experienced no significant differences compared with control group in terms of depression score, quality of life, and medication adherence. Further studies are suggested to investigate the long-term effect of MT with binaural beats. [ABSTRACT FROM AUTHOR]