This study aimed to assess adherence to secondary prevention medications among patients in Nepal following an Acute Coronary Syndrome (ACS) event and to identify factors affecting adherence. ACS was a major cause of morbidity and mortality globally and in Nepal, requiring effective secondary prevention to minimize recurrent cardiovascular events. However, adherence to prescribed medications remained low, especially in low- and middle-income countries like Nepal. Poor adherence could lead to increased healthcare burden, worsened patient outcomes, and higher mortality rates. To address this, the study evaluated patients' medication adherence through the MYMEDS questionnaire, a self-reported tool that was positively received for its simplicity and clarity. Conducted at the Manmohan Cardiothoracic Vascular and Transplant Centre in Nepal, the study involved a sample of adult patients who were readmitted or attending follow-ups post-ACS. The research gathered data on patient demographics, socioeconomic factors, clinical characteristics, and self-reported adherence barriers, analyzing these with SPSS to assess correlations with clinical outcomes.

The 12-month project consisted of phases for ethical approvals, data collection, analysis, and report dissemination. By identifying key barriers to adherence, the study aimed to inform targeted interventions that could enhance medication adherence, improve long-term cardiovascular outcomes, and reduce healthcare burdens in Nepal and other similar settings.

Inclusion Criteria:

• Patients diagnosed with ACS, including ST-Elevation Myocardial Infarction (STEMI), Non-ST-Elevation Myocardial Infarction (NSTEMI), or Unstable Angina within the last 12 months
• Patients aged 18 years and older.
• Patients willing to participate and provide informed consent for the study.

Exclusion Criteria:

• Individuals who have not been diagnosed with ACS or those with other acute or chronic conditions that might influence medication adherence unrelated to ACS.
• Patients with cognitive impairments or mental health issues that prevent them from understanding or responding accurately to the study questionnaires.
• Patients with severe chronic conditions (e.g., terminal illness, advanced dementia) that may affect their ability to adhere to medication regimens.

A sample of adult patients (age ≥18 years) who have either come to OPD for follow-up or have been readmitted for having cardiac complications months after surviving ACS (including STEMI, NSTEMI, and unstable angina) in Manmohan Cardiothoracic Vascular and Transplant Centre, Nepal was selected via convenience sampling.

Individual participant data (IPD) will not be shared because the dataset contains sensitive clinical and sociodemographic information from a relatively small, identifiable group of ACS patients at a single tertiary centre, making robust de-identification difficult in the Nepali context. However, the aggregated findings, such as overall adherence pattern and analysis of demographic factors influencing adherence, will be presented in the final study report.