A randomized trial of direct-to-patient communication to enhance adherence to β-blocker therapy following myocardial infarction

David H. Smith, Judith M. Kramer, Nancy Perrin, Richard Platt, Douglas W. Roblin, Kimberly Lane, Michael Goodman, Winnie W. Nelson, Xiuhai Yang, Stephen B. Soumerai

Research output: Contribution to journalArticlepeer-review

62 Scopus citations


Background: Although β-blockers are routinely prescribed at hospital discharge after myocardial infarction (MI), patients' adherence has been shown to decline substantially over time. We sought to test the hypothesis that a simple, direct-to-patient intervention can improve adherence to β-blocker therapy following MI. Methods: We conducted a cluster randomized controlled trial in 4 geographically dispersed health maintenance organizations testing the hypothesis that a simple direct-to-patient intervention could improve adherence. The study was carried out from June 2004 to March 2005. The primary analyses were based on 836 post-MI patients who were dispensed a β-blocker prescription after discharge. The intervention consisted of 2 mailings 2 months apart describing the importance of β-blocker use. The main outcomes were proportion of days covered with β-blocker therapy and percentage of patients with at least 80% of days covered in the 9 months after the first mailing. Analyses were adjusted for age, sex, total medications dispensed, days between MI and intervention, and intervention site. Results: Over the entire follow-up period, patients in the treatment arm had a mean absolute increase of 4.3% of days covered per month compared with patients in the control arm (a 5.7% relative change from baseline), representing 1.3 extra days (P = .04). Treatment patients were 17% more likely (relative risk, 1.17; 95% confidence interval, 1.02-1.29) to have 80% of days covered. For every 16 patients receiving the intervention, 1 additional patient would become adherent (80% or more days covered per month). Conclusion: A low-cost, easily replicable effort to increase adherence can have a demonstrable impact on β-blocker adherence following MI. Trial Registration: clinicaltrials.gov Identifier: NCT00211172.

Original languageEnglish (US)
Pages (from-to)477-483
Number of pages7
JournalArchives of internal medicine
Issue number5
StatePublished - Feb 26 2008
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine


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