Elderly Medication Adherence Intervention Using the My Interventional Drug-Eluting Stent Educational App: Multisite Randomized Feasibility Trial

Abstract

Background A lifesaving treatment for myocardial infarction is the placement of a stent in a closed or obstructed coronary artery. The largest modifiable risk factor after receiving a stent is medication adherence to Dual AntiPlatelet Therapy, a combination of P2Y12 inhibitors and aspirin. Objective This study aimed to determine the acceptability of a protocol and an intervention using the My Interventional Drug-Eluting Stent Educational App (MyIDEA) and to evaluate medication adherence using the proportion of days covered (PDC) and platelet activation tests in a multisite randomized controlled trial. Methods Potential participants who received a post percutaneous coronary intervention (PCI) procedure with a drug-eluting stent were approached. All patients older than 50 years and who spoke English were recruited. Participants were recruited, baseline demographics were collected, and the Hospital Anxiety and Depression Scale (HADS), Rapid Estimate of Adult Literacy in Medicine-Short Form, Burden-Benefit questionnaire, 36-Item Short Form Health Survey, and PCI knowledge questionnaire were administered. Block randomization was used to randomize participants to either usual care or MyIDEA supplementation. MyIDEA is a personalized educational intervention based on the Kolb experiential learning theory using patient narratives for education. During the visits, participants’ blood was collected to measure platelet suppression from medication. During the second and third encounters, the Morisky medication adherence score and cardiology outcomes were measured. The study was conducted at the University of Illinois Hospital and John H Stroger Jr Cook County Hospital with appropriate ethical approvals. Platelet suppression was measured through aspirin reactive units and P2Y12 reactive units. Medication adherence was measured using the PDC. The analysis team was blinded to the participants’ group membership. The primary outcome was a feasibility analysis of recruitment and retention. Results The mean age of participants was 60.4 years (SD 7.1); the majority of patients were black and non-Hispanic. The majority of patients’ reading levels were seventh grade or above, and they were not very familiar with other electronic devices for information and communication. The number of control subjects was 21, and the number of participants in the interventional arm was 24. The interventional group was able to use MyIDEA in both the hospital and outpatient setting. However, there was no significant difference in platelet suppression or medication adherence between groups. There were also differences between the groups in terms of depression and anxiety, initially, as measured by HADS. No documented adverse event associated with the intervention was found. Conclusions Elderly patients are willing to use tablet devices to be educated about health conditions. Additional studies are required to measure the effectiveness and determine the most suitable timing and location for patient education. Trial Registration ClinicalTrials.gov NCT04439864; https://clinicaltrials.gov/ct2/show/NCT04439864

Smartphone Apps for Managing Antithrombotic Therapy: Scoping Literature Review

“…A randomized feasibility study among 45 patients receiving dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) over 3 months evaluated the impact of the mobile app MyIDEA (My Interventional Drug-Eluting Stent Educational App) on therapy adherence [ 27 ]. MyIDEA educates patients via short stories (ie, patient narratives).…”

Patient Adherence to Therapy After Myocardial Infarction: A Scoping Review

“…16 The most common reasons for discontinuing a medication are ignorance of how long patients will need to take the medication, thus requiring interventions to inform patients. The researches by Riegel and Boyd 16,17 used apps to assess and improve patients' knowledge and adherence to treatment. According to the above mentioned researches elderly patients were in 2020 ready to use electronic tablets to obtain information about their health status after myocardial infarction and secondary prevention of the disease.…”

“…The power of using mobile medical technologies lies in their ability to involve the patient through individualized interventions. 17 One study used by One study used Handbook of Transitional Health Management after percutaneous coronary heart disease evaluated the impact of transitional health management on adherence and prognosis in elderly patients after myocardial infarction. Evaluation of the effect of a transitional treatment regimen on adherence and prognosis in elderly patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention showed an improvement in adherence to treatment.…”

“…The Morisky's adherence questionnaire was used in three studies. 15,17,18 Low adherence to therapy is often found in patients with chronic diseases, in particular with cardiovascular diseases. There is a significant or nearly significant bivariate association with non-compliance with factors such as financial insecurity, poor health literacy, depression, and patient self-identification (nervousness or tension) 15 (Table 4).…”

“…There is a significant or nearly significant bivariate association with non-compliance with factors such as financial insecurity, poor health literacy, depression, and patient self-identification (nervousness or tension) 15 (Table 4). 15,17 The Patient Health Questionnaire was used in two studies and the aspect of identifying oneself as nervous and tense is a factor associated with non-compliance with the treatment regimen. 15,18 The study applying the MyIDEA educational app used the following tools: Hospital Anxiety and Depression Scale, Burden and Benefit Questionnaire, 36-Item Short Form Survey and Morisky`s scale, 17 Dietary compliance questionnaire 12 and CROQ-PTCA-Post.…”