Key result
A smartphone app-based intervention did not significantly improve median edoxaban adherence at 6 months compared to conventional care (98% vs 97.5%; P=.15).
Why the study?
Adherence to oral anticoagulant therapy is essential to prevent ischemic stroke in AF, but whether smartphone app-based interventions improve medication adherence remained to be evaluated.
Does a smartphone app-based intervention improve edoxaban adherence in patients with atrial fibrillation?
RCT (n=498)
Open-label
randomly assigned
Yes
Does a smartphone app-based intervention improve edoxaban adherence in patients with atrial fibrillation?
A smartphone app providing daily alerts did not significantly increase overall median edoxaban adherence but did increase the proportion of patients achieving adequate (≥95%) adherence in patients with atrial fibrillation.
BACKGROUND Adherence to oral anticoagulant therapy is essential to prevent ischemic stroke in patients with atrial fibrillation (AF). OBJECTIVE This study aimed to evaluate whether smartphone app–based interventions improve medication adherence in patients with AF. METHODS This open-label, multicenter randomized controlled trial (ADHERE-App [Self-Awareness of Drug Adherence to Edoxaban Using an Automatic App Feedback System] study) enrolled patients with AF treated with edoxaban for stroke prevention. They were randomly assigned to app-conditioned feedback (intervention; n=248) and conventional treatment (control; n=250) groups. The intervention group received daily alerts via a smartphone app to take edoxaban and measure blood pressure and heart rate at specific times. The control group received only standard, guideline-recommended care. The primary end point was edoxaban adherence, measured by pill count at 3 or 6 months. Medication adherence and the proportion of adequate medication adherence, which was defined as ≥95% of continuous medication adherence, were evaluated. RESULTS Medication adherence at 3 or 6 months was not significantly different between the intervention and control groups (median 98%, IQR 95%-100% vs median 98%, IQR 91%-100% at 3 months, P=.06; median 98%, IQR 94.5%-100% vs median 97.5%, IQR 92.8%-100% at 6 months, P=.15). However, the proportion of adequate medication adherence (≥95%) was significantly higher in the intervention group at both time points (76.8% vs 64.7% at 3 months, P=.01; 73.9% vs 61% at 6 months, P=.007). Among patients aged >65 years, the intervention group showed a higher medication adherence value and a higher proportion of adequate medication adherence (≥95%) at 6 months. CONCLUSIONS There was no difference in edoxaban adherence between the groups. However, the proportion of adequate medication adherence was higher in the intervention group, and the benefit of the smartphone app–based intervention on medication adherence was more pronounced among older patients than among younger patients. Given the low adherence to oral anticoagulants, especially among older adults, using a smartphone app may potentially improve medication adherence. CLINICALTRIAL International Clinical Trials Registry Platform KCT0004754; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=28496&search_page=L INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2021-048777
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Yoon et al. (2024) conducted an RCT in Atrial Fibrillation (n=498). Smartphone app-conditioned feedback vs. Conventional treatment was evaluated on Edoxaban adherence measured by pill count at 6 months (p=.15). A smartphone app-based intervention did not significantly improve median edoxaban adherence at 6 months compared to conventional care (98% vs 97.5%; P=.15).
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