Many post Acute Coronary Syndrome(ACS) patients do not take their medications (including
aspirin) as prescribed, leading to an increase in mortality. Patients enrolled in this study
will be enrolled into one of two groups. Patients in the first group will have their
medication adherence measured, but will receive all other care as usual. Patients in the
second group will also have their medication adherence measured, but they will receive
telephone-delivered problem solving therapy (PST) in addition to their usual care. The two
groups will be combined to determine the Minimally Effective Dose (MED) and the Maximally
Tolerated Dose (MTD) for adherence to aspirin. The medication adherence of the PST group
will improve by 20% (<55% to >75%).
1. Medical eligibility:
1. Patient presenting for staged intervention with positive cardiac history OR
2. Patient with stable CAD who received cardiac admission but does not report chest
3. Patient with stable CAD who has had a cardiac admission in the past.
2. Patient is non-adherent to prescribed medication.
The following exclusion criteria have been set for either safety concerns or concerns that
patients will not be able to complete the protocol:
1. inability to communicate in English or Spanish
2. unwilling to be randomized or to have aspirin in a separate bottle if they use a pill
3. unavailability for the 1 month period of the study (including being unavailable by
phone and/or traveling out of the country)
4. medically unable to receive aspirin (e.g. allergy, contra-indicated, etc)
5. deemed unable to comply with the protocol (either self selected or by indicating
during screening that s/he could not complete all requested tasks). This includes
patients with a level of cognitive impairment indicative of dementia, and patients
with current alcohol or substance abuse.
6. deemed to need immediate psychiatric assessment (e.g., must be hospitalized, or have
some other psychiatric intervention conducted within 72 hours).
7. active psychosis, bipolar disorder, or any overt personality disorder