Evaluation of the Effectiveness of a Patient Centered Educational Mailer Designed to Improve Statin Adherence: A Pragmatic Trial

Abstract

Background: Patients with high total cholesterol have increased risk of cardiovascular disease. National Cholesterol Education Program (NCEP) and American Hearth Association (AHA) guidelines recommend cholesterol lowering with statin medications; however, statin adherence remains poor. We hypothesized that patient-centered education on the 10-year risk for each of the major constituents of Cardiovascular Disease would increase statin adherence and achievement of low-density lipoprotein cholesterol (LDL-C) goal.Methods: Veterans within the Salt Lake City Veterans Affairs (VA) Medical Center initiating statin therapy during October 2008 to December 2011 were randomized in a pragmatic design to either receive an educational mailer or usual care. The mailer outlined their 10-year global cardiovascular risk, separated into coronary heart disease, stroke, and congestive heart failure. The study was unblinded and followed an intention-to-treat analysis where outcome measures were obtained during normal care process. The primary outcome measure was achievement of LDL-C goal during the 12-month follow-up.Results: Two hundred and seven patients were randomly assigned to either the intervention arm (95) or control arm (112). No differences in the proportion of patients meeting LDL-C goal were detected during 12-months [Relative Risk (RR): 0.95 (95%CI: 0.77-1.17)] or 18-months [RR: 1.03 (95%CI: 0.84, 1.25)]. Patients in the intervention arm had higher adherence on average, e.g., intervention patients were more likely to have 70% or more days of statin therapy compared to patients who received standard care though this did not reach statistical significance. [RR: 1.33(95%CI: 1.00, 1.78)] There were no statistical differences in cardiovascular outcomes or mortality.Conclusion: Patient education mailers sent to patients starting statin treatment did not have a clear impact on LDL-C goal achievement or adherence to statin therapy.