Background: Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor is recommended
for at least 12 months in patients after an acute coronary syndrome (ACS). However, its underuse and
premature discontinuation are common in clinical practice. We aimed to investigate the impact of a
dedicated follow-up strategy with clinical visits and counselling on adherence levels to ticagrelor in
patients after ACS.
Methods: PROGRESS (PROmotinG dual antiplatelet therapy adheREnce in the setting of acute coronary
Syndromes) is a prospective, randomized trial enrolling 400 ACS patients treated with ticagrelor.
Patients were randomized to be followed-up in a dedicated outpatient clinic (In-person follow-up group,
[IN-FU], n=200), or with scheduled for phone interviews only (Telephone follow-up group [TEL-FU],
n=200), to assess ticagrelor adherence and related complications. DAPT disruption was defined as an
interruption of the administration of the drug due to complications or other reasons of non-adherence,
and divided according to the duration into short (1-5 days), temporary (6-30 days) and permanent (≥30
days) disruption. The primary endpoint was the rate of DAPT disruption at 1-year follow-up.
Results: The rate of ticagrelor disruption at 1 year follow-up was higher in the TEL-FU group than in
the IN-FU group (19.6 vs 5.5%; p<0.0001). The IN-FU group reported a significantly lower rate of short
(3.0 vs 8.5%; p=0.012) and permanent (2.0 vs 9.6%; p=0.012) disruption than TEL-FU group. The rate
of major bleeding did not differ significantly between the 2 groups (p=0.450).
Conclusion: The PROGRESS trial showed a net reduction in DAPT disruption in patients followed-up
with clinical (in-person) follow-up visits in a dedicated outpatient clinic compared with those scheduled
for phone interviews only.