Interventions supporting long term adherence and decreasing cardiovascular events after myocardial infarction (ISLAND): pragmatic randomised controlled trial

Abstract

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.

Virtual care use before and during the COVID-19 pandemic: a repeated cross-sectional study

“…Prior research suggesting that virtual care may be particularly effective for mental health issues may explain the higher use of virtual care in this population. Virtual care has also been shown to improve care for patients with heart failure, 25 chronic obstructive pulmonary disease, 26 , 27 coronary artery disease 28 and diabetes. 29 Further study is required to understand which diseases and conditions are most amenable to virtual care, the optimal dosing of virtual care (frequency of visits, duration) and the content of visits (e.g., symptom assessment, medication reconciliation).…”

Strategies for enhancing the initiation of cholesterol lowering medication among patients at high cardiovascular disease risk: a qualitative descriptive exploration of patient and general practitioners’ perspectives on a facilitated relay intervention in Alberta, Canada

“…22 While active forms of education, like cognitive education and behavioural counselling seem to work, 53 more passive forms of education are often unsuccessful at changing behaviour, as in a recent trial where the intervention comprised of a mail and phone education strategy to encourage patients to take prescribed medication had no impact on adherence. 54 Others have found that multifaceted interventions focusing on enhancing care provision through team-based care may be effective at increasing statin adherence. 55 However, when trying to target the problem of low statin prescribing, interventions directed only at patients are not likely to work.…”

<p>Moving the Dial on Heart Failure Patient Adherence Rates</p>

“…78 Another study sought to assess the impact of mailed information and interactive phone calls on adherence to medication and cardiac rehabilitation programs after an AMI. 79 None of the interventions resulted in significant increases in medication adherence, possibly pointing to the diminished relevance of printed materials.…”