Abstract
Medication discrepancies and non-adherence during care transitions after acute myocardial infarction (AMI) substantially increase adverse drug events and hospital readmissions. This prospective randomized controlled trial evaluated the clinical impact of a structured, pharmacist-led medication reconciliation and transitional care program on readmission rates, medication discrepancies, and adherence in post-AMI patients. A total of 280 adult AMI patients were randomized 1:1 to receive either standard care (n = 140) or a clinical pharmacist intervention (n = 140) comprising admission reconciliation, inpatient pharmacotherapy optimization, face-to-face discharge education, and a 7-day post-discharge telephone follow-up. The primary outcome was 30-day all-cause hospital readmission. Secondary outcomes included unintentional medication discrepancies at discharge, 30-day medication adherence, and 90-day readmission rates. At 30 days post-discharge, the intervention group demonstrated a statistically significant reduction in all-cause hospital readmission compared to the control group (8.6% vs. 19.3%; hazard ratio = 0.41, 95% CI: 0.21–0.82; p = 0.011). Unintentional medication discrepancies at discharge were present in 12.1% of intervention patients compared to 64.3% of control patients (p < 0.001). High medication adherence at 30 days was achieved by 88.5% of intervention patients versus 67.1% of control patients (p < 0.001). Integrating clinical pharmacists into cardiology multidisciplinary teams significantly reduces discharge medication errors and readmissions while optimizing pharmacotherapy outcomes in post-MI patients.
