Myocardial Ischemia

Rheumatic Diseases

This intervention will consist of: proactive real-time adherence monitoring of patients and targeting of individuals only when they have exhibited non-adherence behavior (i.e., if patients have not refilled their medication more than 4 or 7 days after it was due to be refilled). The intervention will employ a tailored, escalating-intensity approach which begins with some combination of personalized short messaging service (SMS) text messages and interactive voice response (IVR) telephone technology, depending on patient preference. Patients failing SMS and then IVR by not refilling their medication (or declining SMS and failing IVR) escalate to a trained research interventionalist (typically, a clinical pharmacist). The interventionalist will contact the patient and address adherence barriers based on the dimensions outlined by the World Health Organization (WHO) that are specific to each patient.

Caplan IVR

San Francisco VA Medical Center, San Francisco, CA

Rocky Mountain Regional VA Medical Center, Aurora, CO

Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD

Durham VA Medical Center, Durham, NC

VA Caribbean Healthcare System, San Juan, PR

Secondary Event Prevention Using Population Risk Management After PCI and for Anti-Rheumatic Medications

Secondary Event Prevention Using Population Risk Management After PCI

Proportion of Days Covered (PDC) is measured by looking at the number of doses of medication a patient has versus days in the month (if a patient has 20 days of medication for a 30 day period their PDC is 20/30, 2/3, or 66.7%). Used to assess the effectiveness of the intervention, PDC will be tested among IHD patients in the year after PCI and among rheumatology clinic patients chronically prescribed DMARDs.

Cardiovascular Events (CVEs) such as myocardial infarction, and repeat revascularization among IHD patients at 12 months post-PCI and progressive erosive disease demonstrated in patients with rheumatic disease will be monitored. CVEs will be monitored to determine if there is a reduction in the occurrence of those events as a result of the intervention.

To establish the cost to implement and maintain the intervention, above the cost of usual care. Incremental Cost Effectiveness (ICE) is the cost to achieve a 10% improvement in PDC, and the cost of CVE prevented.

VA Office of Research and Development

Hydroxychloroquine 300 mg tablet by mouth daily for 6 months. Patients under the weight of 60 kg: hydroxychloroquine 300 mg tablet daily for 5 days per week for 6 months.

Placebo tablet by mouth daily for 6 months. Patients under the weight of 60 kg: placebo tablet daily for 5 days per week for 6 months.

Myocardial Infarction

Acute Coronary Syndrome

Inflammation

Hydroxychloroquine

Antirheumatic Agents

Cardiovascular Diseases

Placebo

Helsinki University Central Hospital

North Karelia Central Hospital

Kymenlaakso Central Hospital

Päijät-Häme Central Hospital

South Karelia Central Hospital

South Ostrobotnia Central Hospital

Hydroxychloroquine for the Prevention of Cardiovascular Events in Myocardial Infarction Patients - a Safety Pilot Trial

Hydroxychloroquine for the Prevention of Recurrent Cardiovascular Events in Myocardial Infarction Patients - a Safety Pilot Trial

Myocardial infarction, mortality, hospitalization for unstable angina, and heart failure

The effect of hydroxychloroquine on total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels

Frozen samples (plasma and whole blood) will be stored for future evaluation of biomarkers related to inflammation and cardiovascular disease, such as tumor necrosis factor alpha, interleukin 6 (IL-6), IL-1beta, IL-18, and messenger ribonucleic acid (mRNA) analyses.

Study data is planned to be available at the study organization´s website, and by specific request from the investigator

Otto Hartman

Finnish Foundation for Cardiovascular Research

Orion Corporation, Orion Pharma

Aarne Koskelo Foundation

Finnish Cultural Foundation

Rheumatoid Arthritis

Coronary Artery Disease

Inhibition of Interleukin-1 activity by anakinra (Kineret®) 100mg od, sc injection

anakinra

placebo

"Attikon" University General Hospital

Effects of Interleukin-1 Inhibition on Vascular and Left Ventricular Function in Rheumatoid Arthritis Patients With Coronary Artery Disease

The Effect of Inhibition of Interleukin-1 Activity on Vascular and Left Ventricular Function in Patients With Coronary Artery Disease and Coexistent Rheumatoid Arthritis

Improvement in vascular and left ventricular function after administration of anakinra compared to placebo

antirheumatics/infarto

Secondary Event Prevention Using Population Risk Management After PCI and for Anti-Rheumatic Medications

Hydroxychloroquine for the Prevention of Cardiovascular Events in Myocardial Infarction Patients - a Safety Pilot Trial

Effects of Interleukin-1 Inhibition on Vascular and Left Ventricular Function in Rheumatoid Arthritis Patients With Coronary Artery Disease

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