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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Cluster randomized controlled trial of Delayed Educational Reminders for Long-term Medication Adherence in ST-Elevation Myocardial Infarction (DERLA-STEMI)
American Heart Journal, Volume 170, No. 5, Year 2015
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Description
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. © 2015 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license.
Authors & Co-Authors
Schwalm, Jon David Reid
Canada, Hamilton
Hamilton General Hospital
Canada, Hamilton
Mcmaster University
Canada, Ottawa
University of Ottawa
Natarajan, Madhu Kailash
Canada, Hamilton
Hamilton General Hospital
Canada, Hamilton
Mcmaster University
Taljaard, Monica K.
Canada, Ottawa
University of Ottawa
Canada, Ottawa
L'hôpital D'ottawa
Rao-Melacini, Purnima
Canada, Hamilton
Mcmaster University
Witteman, Holly O.
Canada, Quebec
Université Laval
Canada, Quebec
Chu de Québec-université Laval
Zwarenstein, Merrick F.
Canada, London
Western University
Grimshaw, Jeremy M.
Canada, Ottawa
University of Ottawa
Statistics
Citations: 29
Authors: 7
Affiliations: 9
Identifiers
Doi:
10.1016/j.ahj.2015.08.014
ISSN:
00028703
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Randomised Control Trial
Cohort Study
Case-Control Study
Study Approach
Quantitative