Digital Outreach to Improve Statin Refills in Patients With Low Statin Adherence: The ADHERE-ASCVD Randomized Clinical Trial.
Ankeet S Bhatt, Vincent X Liu, Baiyang Sun et al.
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In 30 seconds
The ADHERE-ASCVD pragmatic, health system-embedded randomized clinical trial tested adaptive digital outreach to prompt statin refills among adults with established ASCVD or high ASCVD risk and recent nonadherence. Among 20,604 participants, initial digital outreach increased 14-day refill compared with usual communication (14.4% vs 12.0%; adjusted risk difference, 2.3 percentage points [95% CI, 1.3-3.4]). A second outreach also improved refill among initial nonresponders, while switching communication modalities did not outperform repeating the same modality. Any digital outreach was associated with higher cumulative refill through 28 days.
Key findings
- Initial digital outreach increased 14-day statin refill versus usual communication: 14.4% vs 12.0%; adjusted risk difference, 2.3 percentage points [95% CI, 1.3-3.4].
- Among initial nonresponders, second-stage outreach increased refill versus usual communication: 13.0% vs 10.4%; adjusted risk difference, 2.5 percentage points [95% CI, 1.3-3.7].
- Switching communication modalities did not improve refill compared with repeating the same modality (13.2% vs 12.5%; adjusted risk ratio, 1.06 [95% CI, 0.94-1.17]).
- Cumulative 28-day refill was higher with any digital outreach than usual communication (24.9% vs 21.2%; adjusted hazard ratio, 1.21 [95% CI, 1.13-1.30]).
Why it matters
Statin nonadherence is a modifiable barrier to cardiovascular prevention. This trial indicates that health systems can use sequential digital contact to produce modest improvements in short-term refills, including among people who do not respond initially. The lack of added benefit from changing channels suggests that repeated outreach, rather than modality switching, may be the relevant feature of the tested approach.
What to keep in mind
Follow-up was short, with refill outcomes assessed through 28 days; the study therefore does not establish whether outreach improves sustained statin use or cardiovascular outcomes.