AIM: Low-cost, personal approach improves med usage after MI

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A low-cost, easily replicable effort to increase compliance can have a demonstrable impact on beta-blocker (β-blocker) adherence following MI, according to randomized trial published in the March 10 issue of the Archives of Internal Medicine.

At a cost of $5 to $10 per patient, personalized letters and educational materials sent directly to heart attack patients increased the measure of adherence by 17 percent, the trial found.

More than 13 million adult Americans have coronary heart disease, and more than 7 million have had MI. Heart disease is the number one cause of death in the U.S., costing an estimated $76 billion to treat in 2005.

David H. Smith, RPh, PhD, of the Center for Health Research at Kaiser Permanente Northwest in Portland, Ore., and colleagues noted that while β-blockers are routinely prescribed at hospital discharge after MI, patients' adherence has been shown to decline substantially over time.     

Investigators estimated that if all MI survivors in 2000 in the U.S. persisted with β-blocker use for 20 years, 45,000 life-years would be gained, and that MI patients discontinuing β-blocker use are almost twice as likely to die in the next year.

The researchers conducted a cluster randomized controlled trial in four geographically dispersed health maintenance organizations (Boston; Minneapolis; Atlanta; and Portland, Ore.) testing the hypothesis that a simple direct-to-patient intervention could improve adherence. The authors wrote that the primary analyses, conducted from June 2004 to March 2005, were based on 836 post-MI patients, who were dispensed a β-blocker prescription after discharge.

The investigators reported that the intervention consisted of two mailings: a personalized letter was mailed first, followed approximately two months later by a similar letter and an accompanying brochure, describing the importance of β-blocker use.

The authors wrote that the main outcomes were proportion of days covered with β-blocker therapy and percentage of patients with at least 80 percent of days covered in the nine months after the first mailing.

Smith and colleagues found that over the entire follow-up period, patients in the treatment arm had a mean absolute increase of 4.3 percent of days covered per month compared with patients in the control arm (a 5.7 percent relative change from baseline), representing 1.3 extra days.

Treatment patients were 17 percent more likely to have 80 percent of days covered, according to the researchers. For every 16 patients receiving the intervention, they reported that one additional patient would become adherent (80 percent or more days covered per month).

The authors said the study showed how easily-replicated and inexpensive communications tactics can increase adherence to recommended therapies by educating patients about the importance of continuing drug therapy.