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An Intervention to Improve Post-MI Patient Adherence to Beta-Blockers

A carefully designed study homes in on one component of a complex problem.

Strategies to increase the use of evidence-based medications to improve outcomes after acute MI typically target clinicians. However, the promise of such therapies is also limited by the failure of many patients to take their prescribed medications. Interventions designed to improve adherence to medications are usually multimodal, and identifying which of their components are most effective has been a challenge.

The present study included 836 survivors of acute MI (67% male; average age, 65; average time from MI to randomization, about 136 days) in four U.S. managed healthcare systems. In three systems, patients were cluster-randomized at the practice level; in the fourth, individual patients were randomized. Focus groups were used to develop the format and content of two mailings encouraging beta-blocker use that were sent to patients in the intervention arm: one at randomization and one 2 months later. Patients who received the mailings had a mean absolute increase in days of beta-blocker coverage per month of 4.3% (1.3 days per month), compared with those who did not receive the mailings. Mailing recipients were also 17% more likely than nonrecipients to have at least 80% of days covered overall, amounting to a "number needed to treat" of 16 to achieve 1 additional patient reaching 80% coverage. Use of ACE inhibitors, angiotensin-receptor blockers, and statins did not decrease in the intervention group. The estimated cost of the intervention was between $5 and $10 per patient, depending on the size of the health plan.

Comment: This study illustrates the feasibility of using rigorous methods to study interventions to improve adherence. The intervention achieved relatively small, but arguably clinically important, improvements in adherence, suggesting that a direct mailing of materials developed with the patients’ needs in mind could be a simple, effective, and relatively inexpensive component of programs to address this important problem.

— Frederick A. Masoudi, MD, MSPH

Published in Journal Watch Cardiology March 10, 2008

Citation(s):

Smith DH et al. A randomized trial of direct-to-patient communication to enhance adherence to ß-blocker therapy following acute myocardial infarction. Arch Intern Med 2008 Mar 10; 168:477.

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