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Digital Outreach to Improve Statin Refills in Patients With Low Statin Adherence
Key result
Initial digital outreach increases 14-day statin refills ~20% over usual communication.
- RR 1.20
- 95% CI 1.10-1.30
- n=20,604
Why the trial?
Many patients with atherosclerotic cardiovascular disease become non-adherent to statins within a few years, forfeiting proven benefit. ADHERE-ASCVD asked whether adaptive digital outreach can durably improve statin adherence.
Does an adaptive, sequential digital outreach strategy improve short-term statin refill in adults with established ASCVD or high ASCVD risk and recent nonadherence?
Population
20,604 adults with ASCVD or high risk + recent statin nonadherence (KP N. California)
Comparison
Adaptive digital outreach (portal, SMS, or email) vs usual communication
Design
Pragmatic health system-embedded PROBE trial, 2-stage SMART design
Follow-up
14-day refill after each randomization; 28-day follow-up
Authors
Discussion
No takes yet. Share an insight, caveat, or question.
Where experts stand
Experts see ADHERE-ASCVD as a proof-of-concept that digital nudges can modestly lift statin refills, but note that overall adherence remained low, leaving the clinical impact uncertain.
Cardiologists acknowledge the trial shows digital outreach works better than usual communication, but the absolute improvement is small and most patients still did not refill. Several experts highlight the operational speed and scalability of the approach, while noting that switching communication channels added no extra benefit. The open question is whether these modest refill gains translate into meaningful cardiovascular risk reduction and whether the model can be extended to other conditions like heart failure.
Agreement
Multiple cardiologists note that while a second digital nudge helped non-responders, switching between communication channels offered no additional benefit over repeating the same modality.
2 clinicians say this directly
1 take classified by contention axis so far — the map appears as more land.
Still unclear
Whether a 2.3 percentage-point increase in 14-day statin refills translates into sustained adherence or reduced cardiovascular events remains unknown. The trial investigators have signaled a similar adaptive digital outreach program for heart failure, but results from that extension are pending. It is also unclear how comorbidities may modify the effect of digital outreach.
Key expert perspectives
Andrew P. AmbrosyHeart Failure / Cardiomyopathy · Kaiser Permanente San Francisco Medical CenterPractice takeAug 29Changing modalities added nothing, but the speed from concept to completion shows operational promise
Ambrosy congratulates the investigators and notes that multiple communication channels increased statin use in patients at risk or with ASCVD. He highlights that changing modalities was no more effective as a second nudge, and that the time from concept to completion of under 2 months underscores an opportunity to improve operational efficiency.
Distilled from their postX post
A second nudge helped non-responders, but switching channels gave no extra benefit
Fonarow summarizes the key findings: digital outreach boosted 14-day refills versus usual care, a second nudge helped non-responders, but switching channels provided no additional benefit.
Distilled from their postX post
Investigators plan to extend adaptive digital outreach to heart failure
Busnatu reports from a live Q&A with the trial's principal investigator, noting that a similar adaptive digital outreach program is being developed for heart failure and that the next step involves examining how comorbidities affect response.
Distilled from their postX post
Implication
Adaptive digital outreach raised 14-day statin refill versus usual communication (14.4% vs 12.0%); the absolute gain is modest and most patients still did not refill.
Key Points
- To determine whether an adaptive, sequential digital outreach strategy improves short-term statin refills compared with usual communication among adults with established atherosclerotic cardiovascular disease or high cardiovascular risk and recent nonadherence.
- Pragmatic, 2-stage sequential multiple assignment randomized trial (SMART) using a prospective randomized open blinded end point (PROBE) design within Kaiser Permanente Northern California (N=20,604; NCT07522645).
- Participants were randomized 1:1:1:1 to receive secure portal messaging, SMS/text messaging, nonsecure email, or usual communication; initial 14-day nonresponders were re-randomized to repeat the same outreach, switch modalities, or receive usual communication.
- Initial digital outreach significantly increased 14-day statin refills compared to usual communication (14.4% vs 12.0%; adjusted risk ratio [aRR], 1.20 [95% CI, 1.10-1.30]; adjusted risk difference, 2.3 percentage points [95% CI, 1.3-3.4]).
- Among initial nonresponders, second-stage outreach further improved 14-day refill rates over usual communication (13.0% vs 10.4%; aRR, 1.25 [95% CI, 1.11-1.39]), whereas switching communication modalities provided no additional benefit over repeating the same modality (13.2% vs 12.5%; aRR, 1.06 [95% CI, 0.94-1.17]).
- Cumulative 28-day statin refill rates were significantly higher with any digital outreach compared to usual communication (24.9% vs 21.2%; adjusted hazard ratio, 1.21 [95% CI, 1.13-1.30]).
Evidence details
What drove the result?
| Outcome | Outreach | Usual comm |
|---|---|---|
| 14-day statin refill (initial randomization) | 14.4% | 12.0% |
| aRD 2.3 pp (95% CI 1.3-3.4); aRR 1.20 (1.10-1.30) | ||
| 14-day refill after second-stage outreach (initial nonresponders) | 13.0% | 10.4% |
| aRR 1.25 (1.11-1.39) · switching modality added nothing over repeating (13.2% vs 12.5%; aRR 1.06, 0.94-1.17) | ||
| Cumulative statin refill through 28 days | 24.9% | 21.2% |
| aHR 1.21 (1.13-1.30) for any digital outreach | ||
Limitations & tradeoffs
Representation
conducted in a single integrated system (Kaiser Permanente Northern California), which may limit generalizability.
Design limitations
open-label PROBE design (only endpoint ascertainment was blinded), and short-term refill is a surrogate for sustained adherence and cardiovascular outcomes.
Structured PICO
Does an adaptive, sequential digital outreach strategy improve short-term statin refill in adults with established ASCVD or high ASCVD risk and recent nonadherence?
P
Population
20,604 adults aged ≥18 years with established ASCVD or high ASCVD risk and recent statin nonadherence, followed for 28 days.
I
Intervention
Adaptive, sequential digital outreach strategy (secure portal messaging, SMS/text messaging, or nonsecure email). Initial nonresponders within 14 days underwent prespecified second-stage randomization to repeat the same outreach or switch communication modality.
C
Comparator
Usual communication
O
Outcome
Rates of 14-day statin refill following each randomization, with 28-day follow-up.
Main Result
Relative Risk: 1.2 (95% CI 1.1–1.3)
Absolute Event Rate: 14.4% vs 12%
Absolute Risk Reduction: 2.3%
Adaptive, sequential digital outreach significantly improved short-term statin refills compared to usual communication among patients with recent nonadherence.
Coverage & sources
Journal, society, and media accounts. Useful signal, not independent expert judgment.
Cite This Study
Bhatt et al. (2026) conducted an RCT in Established ASCVD or high ASCVD risk with recent statin nonadherence (n=20,604). Digital outreach (secure portal messaging, SMS/text messaging, nonsecure email) vs. Usual communication was evaluated on Rates of 14-day statin refill following each randomization (RR 1.20, 95% CI 1.10-1.30). Initial digital outreach increased 14-day statin refill compared to usual communication (14.4% vs 12.0%; RR 1.20; 95% CI 1.10-1.30), with second-stage outreach further increasing refills.