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Cluster randomized controlled trial of Delayed Educational Reminders for Long-term Medication Adherence in
Jon-David Schwalm1, Noah M Ivers2, Madhu K Natarajan3
1Heart Investigation Unit, Hamilton General Hospital, Hamilton, ON, Canada; Population Health Research Unit, McMaster University, Hamilton, ON, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada.
Insights
Automated reminders did not improve long-term adherence to cardiac medications after ST-elevation myocardial infarction (STEMI). While adherence scores improved, the persistence of taking all four key medication classes remained unchanged.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Discontinuation of cardiac medications after ST-elevation myocardial infarction (STEMI) is common and linked to higher mortality.
- The DERLA-STEMI study aimed to improve long-term medication adherence in STEMI survivors.
Purpose of the Study:
- To evaluate the effectiveness of an automated, personalized educational reminder intervention on long-term cardiac medication adherence post-STEMI.
Main Methods:
- Cluster randomized trial involving STEMI patients who underwent angiography and survived to discharge.
- Intervention group received mailed reminders at 1, 2, 5, 8, and 11 months post-discharge.
- Primary outcome: proportion of patients taking all four cardiovascular medication classes (aspirin, angiotensin blockers, statin, beta-blocker) at 12 months.
Main Results:
- No significant difference in persistence to all four medication classes between intervention (58.4%) and control (58.9%) groups.
- Medication adherence, measured by the Morisky Score, was significantly better in the intervention group (65.3% vs 58.0%).
Conclusions:
- The study found suboptimal use of guideline-recommended cardiac medications 12 months post-STEMI.
- Repeated postal reminders did not significantly improve persistence to all four key medication classes compared to usual care.
Background:
Discontinuation of guideline-recommended cardiac medications post-ST-elevation myocardial infarction (STEMI) is common and associated with increased mortality. DERLA-STEMI tested an intervention to improve long-term adherence to cardiac medications post-STEMI.
Methods And Results:
Between September 2011 and December 2012, STEMI patients from one health region in Ontario, who underwent an angiogram during their admission and survived to discharge, were cluster randomized (by primary care provider) to intervention or control. The intervention was an automated system of personalized, educational-reminders sent to the patient and their family physician, urging long-term use of secondary-prevention medications. Interventions were mailed at 1, 2, 5, 8, and 11 months after discharge. A total of 852 eligible participants were randomized to intervention (n = 424, 287 clusters) and control (n = 428, 295 clusters); 87% completed a 12-month follow-up. The primary outcome, defined as the proportion of participants taking (persistence) all 4-cardiovascular medication classes (acetylsalicylic acid, angiotensin blockers, statin, and β-blocker) at 12 months, was 58.4% (intervention) and 58.9% (control; adjusted odds ratio 1.03, 95% CI 0.77-1.36). Medication adherence, as assessed by the Morisky Medication Adherence Score, was statistically significantly better in the intervention group as compared with control (65.3% vs 58.0%, adjusted odds ratio 1.35, 95% CI 1.01-1.81).
Conclusion:
The results suggest suboptimal use of 4 of 4 cardiac medication classes at 12 months. There was no significant difference compared with usual care in the persistence to guideline-recommended medications post-STEMI when participants (and their family physicians) receive repeated postal reminders.
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