Related Experiment Video
Updated: Dec 18, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Interventions supporting long term adherence and decreasing cardiovascular events after myocardial infarction
Noah M Ivers1,2,3,4,5,6, Jon-David Schwalm7,8, Zachary Bouck2
1Department of Family and Community Medicine, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S1B2, Canada noah.ivers@utoronto.ca.
Insights
This study found that mail and phone interventions improved cardiac rehabilitation completion after myocardial infarction but not medication adherence. Further research is needed to enhance medication adherence strategies.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Public Health
Background:
- Secondary prevention after myocardial infarction (MI) is crucial for long-term patient outcomes.
- Adherence to prescribed treatments, including cardiac rehabilitation and medications, remains a significant challenge.
- Scalable interventions are needed to support patients in managing their health post-MI.
Purpose of the Study:
- To evaluate a scalable health system intervention aimed at improving long-term adherence to secondary prevention treatments in patients following a myocardial infarction.
- To assess the effectiveness of mail-outs and phone calls in enhancing patient adherence.
Main Methods:
- A pragmatic randomized controlled trial involving 2632 patients across nine cardiac centers in Ontario, Canada.
- Participants were assigned to usual care, mail-out interventions, or mail-outs plus phone calls.
- Co-primary outcomes included cardiac rehabilitation completion and medication adherence, assessed at 12 months by blinded assessors.
Main Results:
- The full intervention (mail plus phone calls) significantly increased cardiac rehabilitation completion rates (37% vs. 27% in usual care, OR 1.55).
- No significant differences in medication adherence were observed between the intervention groups and usual care.
- Patient demographics included a mean age of 66 years, with 71% males.
Conclusions:
- Scalable mail and phone interventions can effectively improve cardiac rehabilitation completion post-MI.
- Current intervention strategies do not significantly enhance medication adherence in this patient population.
- Future research should focus on more intensive interventions to improve medication adherence and explore the link between cardiac rehabilitation attendance and adherence.
Objective:
To test a scalable health system intervention to improve long term adherence to secondary prevention treatments among patients who have had a recent myocardial infarction.
Design:
Three arm, pragmatic randomised controlled trial with blinded outcome assessment.
Setting:
Nine cardiac centres in Ontario, Canada.
Participants:
2632 patients with obstructive coronary artery disease after a myocardial infarction, identified from a centralised cardiac registry.
Interventions:
Participants were randomised 1:1:1 to receive usual care, five mail-outs developed through a user centred design process, or mail-outs plus phone calls. The phone calls were delivered first by an interactive automated system to screen for non-adherence to treatment. Trained lay health workers followed up as necessary. Interventions were coordinated centrally but delivered from each patient's hospital site.
Main Outcome Measures:
Co-primary outcomes were completion of cardiac rehabilitation and adherence to recommended medication. Data were collected by blinded assessors through patient report and from administrative health databases at 12 months.
Results:
2632 patients (mean age 66, 71% male) were randomised: 878 to the full intervention (mail plus phone calls), 878 to mail only, and 876 to usual care. Of the respondents, 174 (27%) of 643 in the usual care group, 200 (32%) of 628 in the mail only group, and 196 (37%) of 531 allocated to the full intervention completed cardiac rehabilitation (adjusted odds ratio 1.55, 95% confidence interval 1.18 to 2.03). In the mail plus phone group, 11.7%, 6.0%, 14.4%, 32.9%, and 35.0% reported adherence to 0, 1, 2, 3, and 4 drug classes after one year, respectively, in comparison with 12.5%, 6.8%, 13.6%, 30.2%, and 36.8% in the mail only group, and 12.2%, 8.4%, 13.1%, 30.3%, and 36.1% in the usual care group, respectively (mail only v usual care, odds ratio 0.98, 95% confidence interval 0.81 to 1.19; full intervention v usual care, 0.99, 0.82 to 1.20).
Conclusions:
Scalable interventions delivered by mail plus phone can increase completion of cardiac rehabilitation after myocardial infarction but not adherence to medication. More intensive interventions should be tested to improve adherence to medication and to evaluate the association between attendance at cardiac rehabilitation and adherence to medication.
Trial Registration:
ClinicalTrials.gov NCT02382731, registered 9 March 2015 before any patient enrolment.
More Related Videos
14:35Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:26Atherosclerosis III: Management
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Coronary Artery Disease IV: Preventive Measures
01:27Peripheral Artery Disease III: Interprofessional Care
01:29Cardiomyopathy V: Interprofessional Care