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Delayed educational reminders for long-term medication adherence in ST-elevation myocardial infarction (DERLA-STEMI):
Noah M Ivers1, Jon-David Schwalm, Jeremy M Grimshaw
1Family Practice Health Centre, Women's College Research Institute, Women's College Hospital, 76 Grenville Ave Toronto, Toronto, Ontario, Canada. noah.ivers@utoronto.ca
Insights
This study tested personalized mailings to improve medication adherence after heart attacks. The intervention aimed to increase the proportion of patients taking cardiac medications long-term, reducing mortality risks.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Medication adherence declines post ST-elevation myocardial infarction despite evidence-based recommendations.
- Discontinuation of cardiac medications is linked to increased mortality in these patients.
Purpose of the Study:
- To evaluate a pragmatic, cluster-randomized trial assessing the effectiveness of personalized educational messages and reminders on long-term cardiac medication adherence.
- To improve secondary prevention medication use in ST-elevation myocardial infarction survivors.
Main Methods:
- A cluster-randomized controlled trial involving ST-elevation myocardial infarction patients in Ontario, Canada.
- Intervention: recurrent, personalized, paper-based educational messages and reminders sent via post.
- Primary outcome: self-reported adherence to all relevant cardiac medication classes at 12 months, validated with administrative data.
Main Results:
- The primary outcome data is not yet available in the provided abstract.
- Secondary outcomes include medication use, side effects, adherence scores, and physician discussions at 3 and 12 months.
- A qualitative process evaluation is embedded to understand intervention optimization.
Conclusions:
- The intervention is designed for broad generalizability and potential implementation.
- If ineffective, the process evaluation will provide insights for optimizing future adherence strategies.
- The study aims to reduce mortality by improving long-term cardiac medication adherence.
Background:
Despite evidence-based recommendations supporting long-term use of cardiac medications in patients post ST-elevation myocardial infarction, adherence is known to decline over time. Discontinuation of cardiac medications in such patients is associated with increased mortality.
Methods/Design:
This is a pragmatic, cluster-randomized controlled trial with blinded outcome assessment and embedded qualitative process evaluation. Patients from one health region in Ontario, Canada who undergo a coronary angiogram during their admission for ST-elevation myocardial infarction and who survive their initial hospitalization will be included. Allocation of eligible patients to intervention or usual care will take place within one week after the angiogram using a computer-generated random sequence. To avoid treatment contamination, patients treated by the same family physician will be allocated to the same study arm. The intervention consists of recurrent, personalized, paper-based educational messages and reminders sent via post on behalf of the interventional cardiologist to the patient, family physician, and pharmacist urging long-term adherence to secondary prevention medications. The primary outcome is the proportion of patients who report in a phone interview taking all relevant classes of cardiac medications at twelve months. Secondary outcomes to be measured at three and twelve months include proportions of patients who report: actively taking each cardiac medication class of interest (item-by-item); stopping medications due to side effects; taking one or two or three medication classes concurrently; a perfect Morisky Medication Adherence Score for cardiac medication compliance; and having a discussion with their family physician about long-term adherence to cardiac medications. Self-reported measures of adherence will be validated using administrative data for prescriptions filled.
Discussion:
This intervention is designed to be easily generalizable. If effective, it could be implemented broadly. If it does not change medication utilization, the process evaluation will offer insights regarding how such an intervention could be optimized in future.
Trial Registration:
Clinicaltrials.gov NCT01325116.
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