ADHERE-ASCVD
Adherence to Dyslipidemia Therapy: Harnessing Evidence From Randomized Evaluations in AtheroSclerotic CardioVascular Disease
Paciente / Población Intervención / Exposición Comparación Desenlace
In 20,604 statin-non-adherent patients with cardiovascular disease or diabetes, adaptive digital outreach was compared with usual care on a statin refill within 14 days.
N
20.604pacientes
Diseño
pragmatic two-stage sequential multiple assignment randomised trial (SMART) embedded in Kaiser Permanente Northern California; first-stage randomisation to outreach by SMS, secure patient-portal message, non-secure e-mail, or usual care; non-refillers at 14 days re-randomised to the same or a different channel or usual care (13 sequences in total); care providers, investigators and outcome assessors masked; refills ascertained from pharmacy dispensing records; persistence and adherence tracked to 12 months
Desenlace
Proportion of participants who refill a statin prescription within 14 days of message delivery, after the first-stage outreach and, among non-responders, after the second-stage outreach
ResultadoStage 1: 14-day statin refill 14.4% with any digital outreach vs 12.0% usual communication (aRD 2.3 percentage points, 95% CI 1.3-3.4; aRR 1.20, 95% CI 1.10-1.30); secure portal 14.9% (aRR 1.24, 95% CI 1.11-1.36), SMS 14.4% (aRR 1.21, 95% CI 1.09-1.33), non-secure e-mail 13.9% (aRR 1.15, 95% CI 1.03-1.27). Stage 2 (initial non-responders): 13.0% vs 10.4% (aRD 2.5 percentage points, 95% CI 1.3-3.7; aRR 1.25, 95% CI 1.11-1.39); switching vs repeating modality 13.2% vs 12.5% (aRR 1.06, 95% CI 0.94-1.17). 28-day cumulative refill 24.9% vs 21.2% (aHR 1.21, 95% CI 1.13-1.30).
Bhatt AS, Liu VX, Sun B, et al. Digital Outreach to Improve Statin Refills in Patients With Low Statin Adherence: The ADHERE-ASCVD Randomized Clinical Trial. JAMA. Published online August 29, 2026. doi:10.1001/jama.2026.16372 10.1001/jama.2026.16372