Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 1/2024

Open Access 22-01-2024 | Pacemaker | Original Research

Informational Postcards Increase Engagement with Remote Monitoring Among Veterans with Pacemakers and Implantable Cardioverter-Defibrillators: a Stepped-Wedge Randomized Controlled Trial

Authors: Megan M. McLaughlin, MD, MPH, Merritt H. Raitt, MD, Gary Tarasovsky, BS, Mary A. Whooley, MD, Sanket S. Dhruva, MD, MHS

Published in: Journal of General Internal Medicine | Special Issue 1/2024

Login to get access

Abstract

Background

Remote monitoring (RM) of pacemakers and implantable cardioverter-defibrillators (ICDs) reduces morbidity and mortality. However, many patients are not adherent to RM.

Objective

To test the effect of informational postcards on RM adherence.

Design/Patients

Stepped-wedge randomized controlled trial among Veterans with pacemakers and ICDs.

Intervention

In wave 1, Veterans who had sent at least 1 transmission within the past 2 years but had become non-adherent were randomly assigned to receive a postcard or no postcard. Those receiving postcards were randomized to 1 of 2 messages: (1) a”warning” postcard describing risks of non-adherence or (2) an “encouraging” postcard describing benefits of adherence. In wave 2, Veterans who had either not received a postcard in wave 1 or had since become non-adherent were mailed a postcard (again, randomized to 1 of 2 messages). Patients who did not send an RM transmission within 1 month were mailed a second, identical postcard.

Main Measures

Transmission within 70 days.

Key Results

Overall, 6351 Veterans were included. In waves 1 and 2, postcards were mailed to 5657 Veterans (2821 “warning” messages and 2836 “encouraging” messages). Wave 1 included 2178 Veterans as controls (i.e., not mailed a postcard), some of whom received a postcard in wave 2 if they remained non-adherent. In wave 2, 3473 postcards were sent. Of the 5657 patients mailed a postcard, 2756 (48.7%) sent an RM transmission within 70 days, compared to 530 (24.3%) of 2178 controls (absolute difference 24.4%, 95% confidence interval [CI] 22.2%, 26.6%). Of those who sent a transmission, 71.8% did so after the first postcard. Transmission rates at 70 days did not significantly differ between “warning” and “encouraging” messages (odds ratio 1.04, 95% CI 0.92, 1.18).

Conclusions

Informational postcards led to a 24.4% absolute increase in adherence at 70 days among Veterans with pacemakers and ICDs who were non-adherent to RM.
Appendix
Available only for authorised users
Literature
1.
Slotwiner D, Varma N, Akar JG, Annas G, Beardsall M, Fogel RI, et al. HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices. Heart Rhythm. 2015;12(7):e69-100.
2.
Ferrick AM, Raj SR, Deneke T, Kojodjojo P, Lopez-Cabanillas N, Abe H, et al. 2023 HRS/EHRA/APHRS/LAHRS expert consensus statement on practical management of the remote device clinic. Heart Rhythm. 2023.
3.
Parthiban N, Esterman A, Mahajan R, Twomey DJ, Pathak RK, Lau DH, et al. Remote monitoring of implantable cardioverter-defibrillators: a systematic review and meta-analysis of clinical outcomes. J Am Coll Cardiol. 2015;65(24):2591-600.
4.
Mabo P, Victor F, Bazin P, Ahres S, Babuty D, Da Costa A, et al. A randomized trial of long-term remote monitoring of pacemaker recipients (the COMPAS trial). Eur Heart J. 2012;33(9):1105-11.
5.
Varma N, Michalski J, Epstein AE, Schweikert R. Automatic remote monitoring of implantable cardioverter-defibrillator lead and generator performance: the Lumos-T Safely RedUceS RouTine Office Device Follow-Up (TRUST) trial. Circ Arrhythm Electrophysiol. 2010;3(5):428-36.
6.
Guédon-Moreau L, Lacroix D, Sadoul N, Clémenty J, Kouakam C, Hermida JS, et al. A randomized study of remote follow-up of implantable cardioverter defibrillators: safety and efficacy report of the ECOST trial. Eur Heart J. 2013;34(8):605-14.
7.
Piccini JP, Mittal S, Snell J, Prillinger JB, Dalal N, Varma N. Impact of remote monitoring on clinical events and associated health care utilization: A nationwide assessment. Heart Rhythm. 2016;13(12):2279-86
8.
Akar JG, Bao H, Jones PW, Wang Y, Varosy PD, Masoudi FA, et al. Use of remote monitoring is associated with lower risk of adverse outcomes among patients with implanted cardiac defibrillators. Circ Arrhythm Electrophysiol. 2015;8(5):1173-80
9.
Mittal S, Piccini JP, Snell J, Prillinger JB, Dalal N, Varma N. Improved survival in patients enrolled promptly into remote monitoring following cardiac implantable electronic device implantation. J Interv Card Electrophysiol. 2016;46(2):129-36
10.
Varma N, Piccini JP, Snell J, Fischer A, Dalal N, Mittal S. The relationship between level of adherence to automatic wireless remote monitoring and survival in pacemaker and defibrillator patients. J Am Coll Cardiol. 2015;65(24):2601-10.
11.
Hindricks G, Varma N, Kacet S, Lewalter T, Søgaard P, Guédon-Moreau L, et al. Daily remote monitoring of implantable cardioverter-defibrillators: insights from the pooled patient-level data from three randomized controlled trials (IN-TIME, ECOST, TRUST). Eur Heart J. 2017;38(22):1749-55.
12.
Klersy C, Boriani G, De Silvestri A, Mairesse GH, Braunschweig F, Scotti V, et al. Effect of telemonitoring of cardiac implantable electronic devices on healthcare utilization: a meta-analysis of randomized controlled trials in patients with heart failure. Eur J Heart Fail. 2016;18(2):195-204.
13.
Watanabe E, Yamazaki F, Goto T, Asai T, Yamamoto T, Hirooka K, et al. Remote management of pacemaker patients with biennial in-clinic evaluation: continuous home monitoring in the Japanese at-home study: a randomized clinical trial. Circ Arrhythm Electrophysiol. 2020;13(5):e007734.
14.
Chiu CSL, Timmermans I, Versteeg H, Zitron E, Mabo P, Pedersen SS, et al. Effect of remote monitoring on clinical outcomes in European heart failure patients with an implantable cardioverter-defibrillator: secondary results of the REMOTE-CIED randomized trial. Europace. 2022;24(2):256-67.
15.
García-Fernández FJ, Osca Asensi J, Romero R, Fernández Lozano I, Larrazabal JM, Martínez Ferrer J, et al. Safety and efficiency of a common and simplified protocol for pacemaker and defibrillator surveillance based on remote monitoring only: a long-term randomized trial (RM-ALONE). Eur Heart J. 2019;40(23):1837-46.
16.
Ladapo JA, Turakhia MP, Ryan MP, Mollenkopf SA, Reynolds MR. Health care utilization and expenditures associated with remote monitoring in patients with implantable cardiac devices. The Am J Cardiol. 2016;117(9):1455-62.
17.
Perl S, Stiegler P, Rotman B, Prenner G, Lercher P, Anelli-Monti M, et al. Socio-economic effects and cost saving potential of remote patient monitoring (SAVE-HM trial). Int J Cardiol. 2013;169(6):402-7.
18.
Timmermans I, Meine M, Szendey I, Aring J, Romero Roldán J, van Erven L, et al. Remote monitoring of implantable cardioverter defibrillators: Patient experiences and preferences for follow-up. Pacing Clin Electrophysiol. 2019;42(2):120-9.
19.
Magnocavallo M, Vetta G, Bernardini A, Piro A, Mei MC, Di Iorio M, et al. Impact of COVID-19 pandemic on cardiac electronic device management and role of remote monitoring. Card Electrophysiol Clin. 2022;14(1):125-31.
20.
Piro A, Magnocavallo M, Della Rocca DG, Neccia M, Manzi G, Mariani MV, et al. Management of cardiac implantable electronic device follow-up in COVID-19 pandemic: Lessons learned during Italian lockdown. J Cardiovasc Electrophysiol. 2020;31(11):2814-23.
21.
Kumar S, Haqqani H, Wynn G, Pathak RK, Lipton J, Mahajan R, et al. Position statement on the management of cardiac electrophysiology and cardiac implantable electronic devices in Australia during the COVID-19 pandemic: a living document. Heart Lung Circ. 2020;29(6):e57-e68.
22.
23.
The Task Force for the management of COVID-19 of the European Society of Cardiology. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Eur Heart J. 2022;43(11):1059–103.
24.
Varma N, Marrouche NF, Aguinaga L, Albert CM, Arbelo E, Choi JI, et al. HRS/EHRA/APHRS/LAHRS/ACC/AHA worldwide practice update for telehealth and arrhythmia monitoring during and after a pandemic. J Arrhythm. 2020;36(5):813-26.
25.
Varma N, Michalski J, Stambler B, Pavri BB. Superiority of automatic remote monitoring compared with in-person evaluation for scheduled ICD follow-up in the TRUST trial - testing execution of the recommendations. Eur Heart J. 2014;35(20):1345-52.
26.
Rosenfeld LE, Patel AS, Ajmani VB, Holbrook RW, Brand TA. Compliance with remote monitoring of ICDs/CRTDs in a real-world population. Pacing Clin Electrophysiol. 2014;37(7):820-7.
27.
Muniyappa AN, Raitt MH, Judson GL, Shen H, Tarasovsky G, Whooley MA, et al. Factors associated with remote monitoring adherence for cardiovascular implantable electronic devices. Heart Rhythm. 2022;19(9):1499-507.
28.
Cronin EM, Ching EA, Varma N, Martin DO, Wilkoff BL, Lindsay BD. Remote monitoring of cardiovascular devices: a time and activity analysis. Heart Rhythm. 2012;9(12):1947-51.
29.
Harvey M, Seiler A. Challenges in managing a remote monitoring device clinic. Heart Rhythm O2. 2022;3(1):3–7.
30.
Staley H, Shiraz A, Shreeve N, Bryant A, Martin-Hirsch PP, Gajjar K. Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database Syst Rev. 2021;9(9):Cd002834.
31.
Thomas RE, Lorenzetti DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database Syst Rev. 2018;5(5):Cd005188.
32.
Bonfill X, Marzo M, Pladevall M, Martí J, Emparanza JI. Strategies for increasing women participation in community breast cancer screening. Cochrane Database Syst Rev. 2001;2001(1):Cd002943.
33.
Jacobson Vann JC, Jacobson RM, Coyne-Beasley T, Asafu-Adjei JK, Szilagyi PG. Patient reminder and recall interventions to improve immunization rates. Cochrane Database Syst Rev. 2018;1(1):Cd003941.
34.
Rothman AJ, Salovey P. Shaping perceptions to motivate healthy behavior: the role of message framing. Psychol Bull. 1997;121(1):3-19.
35.
Gao R, Guo H, Li F, Liu Y, Shen M, Xu L, et al. The effects of health behaviours and beliefs based on message framing among patients with chronic diseases: a systematic review. BMJ Open. 2022;12(1):e055329.
36.
Gantiva C, Jiménez-Leal W, Urriago-Rayo J. Framing Messages to Deal With the COVID-19 Crisis: The Role of Loss/Gain Frames and Content. Front Psychol. 2021;12:568212.
37.
Bartels RD, Kelly KM, Rothman AJ. Moving beyond the function of the health behaviour: the effect of message frame on behavioural decision-making. Psychol Health. 2010;25(7):821-38.
38.
O'Keefe DJ, Nan X. The relative persuasiveness of gain- and loss-framed messages for promoting vaccination: a meta-analytic review. Health Commun. 2012;27(8):776-83.
39.
O'Keefe DJ, Jensen JD. The relative persuasiveness of gain-framed and loss-framed messages for encouraging disease detection behaviors: A meta-analytic review. J Commun. 2009;59(2):296-316.
40.
O'Keefe DJ, Jensen JD. The relative persuasiveness of gain-framed and loss-framed messages for encouraging disease prevention behaviors: a meta-analytic review. J Health Commun. 2007;12(7):623-44.
41.
Handley MA, Schillinger D, Shiboski S. Quasi-experimental designs in practice-based research settings: design and implementation considerations. J Am Board Fam Med. 2011;24(5):589-96.
42.
Milkman KL, Gandhi L, Patel MS, Graci HN, Gromet DM, Ho H, et al. A 680,000-person megastudy of nudges to encourage vaccination in pharmacies. Proc Natl Acad Sci USA. 2022;119(6).
43.
Dai H, Saccardo S, Han MA, Roh L, Raja N, Vangala S, et al. Behavioural nudges increase COVID-19 vaccinations. Nature. 2021;597(7876):404-9.
44.
Szilagyi PG, Albertin C, Casillas A, Valderrama R, Duru OK, Ong MK, et al. Effect of patient portal reminders sent by a health care system on Influenza vaccination rates: a randomized clinical trial. JAMA Intern Med. 2020;180(7):962-70.
45.
Lavalle C, Magnocavallo M, Bernardini A, Vetta G, Bianchi V, Mattera A, et al. A mobile app for improving the compliance with remote management of patients with cardiac implantable devices: a multicenter evaluation in clinical practice. J Interv Card Electrophysiol. 2022;64(1):257-64.
46.
Tarakji KG, Zaidi AM, Zweibel SL, Varma N, Sears SF, Allred J, et al. Performance of first pacemaker to use smart device app for remote monitoring. Heart Rhythm O2. 2021;2(5):463–71.
47.
Mantini N, Borne RT, Varosy PD, Rosenberg MA, Marzec LN, Sauer WH, et al. Use of cell phone adapters is associated with reduction in disparities in remote monitoring of cardiac implantable electronic devices. J Interv Card Electrophysiol. 2021;60(3):469-75.
48.
Etingen B, Amante DJ, Martinez RN, Smith BM, Shimada SL, Richardson L, et al. Supporting the implementation of connected care technologies in the Veterans Health Administration: cross-sectional survey findings from the Veterans Engagement with Technology Collaborative (VET-C) cohort. J Particip Med. 2020;12(3):e21214.
49.
Finkelstein A. A Strategy for Improving U.S. Health Care Delivery - Conducting More Randomized, Controlled Trials. N Engl J Med. 2020;382(16):1485–8.
50.
O'Shea CJ, Middeldorp ME, Hendriks JM, Brooks AG, Lau DH, Emami M, et al. Remote monitoring alert burden: an analysis of transmission in >26,000 Patients. JACC Clin Electrophysiol. 2021;7(2):226-34.
Metadata
Title
Informational Postcards Increase Engagement with Remote Monitoring Among Veterans with Pacemakers and Implantable Cardioverter-Defibrillators: a Stepped-Wedge Randomized Controlled Trial
Authors
Megan M. McLaughlin, MD, MPH
Merritt H. Raitt, MD
Gary Tarasovsky, BS
Mary A. Whooley, MD
Sanket S. Dhruva, MD, MHS
Publication date
22-01-2024
Publisher
Springer International Publishing
Published in
Journal of General Internal Medicine / Issue Special Issue 1/2024
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-023-08478-9

Other articles of this Special Issue 1/2024

Journal of General Internal Medicine 1/2024 Go to the issue

Original Research: Qualitative Research

Implementation of Direct-to-Patient Mobile Teledermatology in VA

Editorial

20 Years of Telehealth in the Veterans Health Administration: Taking Stock of Our Past and Charting Our Future

Narrative Review

Improving Veteran Engagement with Virtual Care Technologies: a Veterans Health Administration State of the Art Conference Research Agenda

Original Research

Telehealth Access and Substitution in the VHA

Original Research

Disparities in Video-Based Primary Care Use Among Veterans with Cardiovascular Disease

Original Research

The Clinical Resource Hub Telehealth Program and Use of Primary Care, Emergency, and Inpatient Care During the COVID-19 Pandemic
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits