Can Digital Outreach Strategies Improve Statin Adherence?
Suboptimal statin adherence remains a major driver of preventable cardiovascular events globally. Therefore, health systems actively explore automated interventions to encourage timely prescription refills. Recently, the ADHERE-ASCVD randomized clinical trial evaluated whether sequential digital messaging could boost medication collection. Published in JAMA, this pragmatic trial provides valuable insights for population health and cardiovascular risk management.
Key Findings on Statin Adherence from ADHERE-ASCVD
The trial enrolled 20,604 adults with established cardiovascular disease or elevated cardiovascular risk. All participants had demonstrated recent poor adherence to their lipid-lowering therapy. Initially, researchers randomized patients to receive portal messaging, SMS text alerts, nonsecure email, or usual communication. Consequently, initial digital outreach significantly increased 14-day statin refill rates compared to usual care. Specifically, refill rates reached 14.4% in the digital group versus 12.0% in the usual communication group. Furthermore, the adjusted risk ratio showed a statistically significant 20% relative improvement.
Adaptive Strategies and Sequential Outreach
The study also evaluated how initial nonresponders reacted to a second round of outreach. Among nonresponders, a second notification raised 14-day refill rates to 13.0% compared to 10.4% with usual care. However, switching the messaging modality provided no added advantage over repeating the original modality. In fact, repeat messaging yielded similar refill rates whether patients switched formats or kept the same format. Overall, cumulative 28-day statin refills reached 24.9% with digital outreach compared to 21.2% with usual care. Thus, sequential reminders delivered tangible cumulative gains across diverse patient subgroups.
Clinical Implications for Preventive Cardiology
Cardiovascular disease remains the leading cause of premature mortality across low- and middle-income regions like India. Unfortunately, real-world discontinuation of lipid-lowering drugs frequently diminishes long-term cardiovascular protection. As a result, automated reminders via SMS or WhatsApp present a cost-effective strategy for clinical practices. Moreover, clinics can seamlessly integrate automated nudges into existing electronic medical records or hospital management software. Nevertheless, digital outreach alone cannot solve all barriers to long-term medication persistence. Hence, clinicians must combine automated reminders with structured patient education and dedicated clinical follow-up.
Frequently Asked Questions
Q1: What did the ADHERE-ASCVD trial evaluate?
The ADHERE-ASCVD trial assessed whether sequential, automated digital messages like SMS, email, or patient portal alerts could improve short-term statin refills among nonadherent patients with cardiovascular disease or high risk.
Q2: Did switching digital communication channels improve refill rates?
No, switching to a different digital channel did not produce higher refill rates compared to repeating the original communication method for initial nonresponders.
Q3: How can physicians apply these findings in clinical practice?
Healthcare systems can deploy automated digital reminders and sequential follow-up nudges to help re-engage nonadherent patients and promote timely prescription renewals.
References
- Bhatt AS et al. Digital Outreach to Improve Statin Refills in Patients With Low Statin Adherence: The ADHERE-ASCVD Randomized Clinical Trial. JAMA. 2026 Aug 29. doi: 10.1001/jama.2026.16372. PMID: 42667613.
- Rodriguez F, Maron DJ, Knowles JW, et al. Association of Statin Adherence With Mortality in Patients With Atherosclerotic Cardiovascular Disease. JAMA Cardiol. 2019;4(3):206-213.
