YMHJ
4991
S0002-8703(15)00534-7
10.1016/j.ahj.2015.08.014
The Authors
Subject codes: (119) compliance/adherence, (122) secondary prevention, (3) acute coronary syndromes, (4) acute myocardial infarction.
Trial Registration: ClinicalTrials.gov (NCT01325116).
Clinical Investigation
Cluster randomized controlled trial of Delayed Educational Reminders for Long-term Medication Adherence in ST-Elevation Myocardial Infarction (DERLA-STEMI)
Jon-David
Schwalm
MD, MSc
a
b
c
⁎
schwalj@mcmaster.ca
Noah M.
Ivers
MD, PhD
d
e
Madhu K.
Natarajan
MD, MSc
a
b
Monica
Taljaard
PhD
c
f
Purnima
Rao-Melacini
MSc
b
Holly O.
Witteman
PhD
g
h
i
Merrick
Zwarenstein
MBBCh, MSc, PhD
j
Jeremy M.
Grimshaw
MBCHB, PhD
c
k
a
Heart Investigation Unit, Hamilton General Hospital, Hamilton, ON, Canada
Heart Investigation Unit, Hamilton General Hospital
Hamilton
ON
Canada
b
Population Health Research Unit, McMaster University, Hamilton, ON, Canada
Population Health Research Unit, McMaster University
Hamilton
ON
Canada
c
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada
Department of Epidemiology and Community Medicine, University of Ottawa
Ottawa
ON
Canada
d
Family Practice Health Centre, Women's College Research Institute and Institute for Health Systems Solutions, Women's College Hospital, Toronto, ON, Canada
Family Practice Health Centre, Women's College Research Institute and Institute for Health Systems Solutions, Women's College Hospital
Toronto
ON
Canada
e
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
Department of Family and Community Medicine, University of Toronto
Toronto
ON
Canada
f
Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa Hospital, Ottawa, ON, Canada
Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa Hospital
Ottawa
ON
Canada
g
Department of Family and Emergency Medicine, University of Laval, Quebec City, QC, Canada
Department of Family and Emergency Medicine, University of Laval
Quebec City
QC
Canada
h
Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval
Quebec City
QC
Canada
i
Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, QC, Canada
Research Centre of the Centre Hospitalier Universitaire de Québec
Quebec City
QC
Canada
j
Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University
London
ON
Canada
k
Department of Medicine, University of Ottawa, Ottawa, ON, Canada
Department of Medicine, University of Ottawa
Ottawa
ON
Canada
⁎
Reprint requests: Jon-David Schwalm, MD, MSc, McMaster University/Hamilton Health Sciences, Population Health Research Institute, 237 Barton Street East, DBCVSRI, C3-108, Hamilton, ON, Canada L8L 2X2.
McMaster University/Hamilton Health Sciences, Population Health Research Institute
237 Barton Street East, DBCVSRI, C3-108
Hamilton
ON
L8L 2X2
Canada
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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2015-08-20T01:08:51Z
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