What happened
Initial digital outreach increases 14-day statin refills ~20% over usual communication.
Multiple experts highlight that while a second digital nudge helped non-responders refill statins, switching the communication channel offered no additional benefit.
Experts see ADHERE-ASCVD as proof that digital nudges can modestly improve statin refills, but the persistently low overall refill rates temper enthusiasm about real-world impact.
Cardiologists acknowledge that adaptive digital outreach statistically improved statin refills over usual communication, but several note the absolute gains were small and overall adherence remained low. There is agreement that switching communication channels as a second nudge added no extra benefit, while a repeated nudge to non-responders did help. The live question is whether these modest digital interventions can be scaled or refined enough to meaningfully move long-term cardiovascular outcomes.
Experts note that overall refill rates remained low even in the intervention arm, leaving open whether digital outreach alone can produce clinically meaningful improvements in long-term statin adherence.
The trial investigators mentioned plans to extend adaptive digital outreach to heart failure and to examine the role of comorbidities, but it is unclear how these refinements will change outcomes.
“Statins are very effective in lowering cardiovascular risk. However, adherence to this treatment is suboptimal nationally. Finding strategies that help people not miss refilling these potentially life-saving medicines was our motivation for this work, and we were pleased to see that we found a strategy that was successful.”
News Coverage ↗From published coverage, not an answer posted here.
Changing modalities added nothing, but the speed from concept to completion signals operational promise
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Digital outreach boosted 14-day refills and a second nudge helped, but switching channels did not
X post ↗Martha Gulati
ContextCardiologistPreviewed the trial as a test of whether a text, email, or portal message can improve statin adherence, framing it as part of the broader evolution of digital health in prevention.
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Reported from the live Q&A that a similar adaptive digital outreach program is planned for heart failure and that investigators will look more closely at comorbidities.
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Why the trial, key points, tables, limitations, PICO, abstract, media & sources
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?
| 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 | ||
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.
Does an adaptive, sequential digital outreach strategy improve short-term statin refill in adults with established ASCVD or high ASCVD risk and recent nonadherence?
An adaptive, sequential digital outreach strategy significantly improved short-term statin refills among patients with recent nonadherence compared to usual communication.
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Expert reaction
JAMA · ESC Congress 2026
2 experts have reacted so far. We show the split once 3 have.
Expert labels are toward ADHERE-ASCVD's result, from named public quotes (n=2). As of Aug 30, 2026.
Experts see ADHERE-ASCVD as proof that digital nudges can modestly improve statin refills, but the persistently low overall refill rates temper enthusiasm about real-world impact.
Cardiologists acknowledge that adaptive digital outreach statistically improved statin refills over usual communication, but several note the absolute gains were small and overall adherence remained low. There is agreement that switching communication channels as a second nudge added no extra benefit, while a repeated nudge to non-responders did help. The live question is whether these modest digital interventions can be scaled or refined enough to meaningfully move long-term cardiovascular outcomes.
Multiple experts highlight that while a second digital nudge helped non-responders refill statins, switching the communication channel offered no additional benefit.
1 take classified by contention axis so far — the map appears as more land.
Experts note that overall refill rates remained low even in the intervention arm, leaving open whether digital outreach alone can produce clinically meaningful improvements in long-term statin adherence. The trial investigators mentioned plans to extend adaptive digital outreach to heart failure and to examine the role of comorbidities, but it is unclear how these refinements will change outcomes.
“Statins are very effective in lowering cardiovascular risk. However, adherence to this treatment is suboptimal nationally. Finding strategies that help people not miss refilling these potentially life-saving medicines was our motivation for this work, and we were pleased to see that we found a strategy that was successful.”
Andrew P. AmbrosyHeart Failure / Cardiomyopathy · Kaiser Permanente Northern California / The Permanente Medical Group, San FranciscoPractice takeAug 29Ambrosy highlights that multiple communication channels increased statin use in patients at risk or with ASCVD, but changing modalities was no more effective as a second nudge. He notes the trial went from concept to completion in under two months, underscoring the opportunity to improve operational efficiency in health systems.
Fonarow summarizes that digital outreach via portal, text, and email increased 14-day statin refills versus usual care (14.4% vs 12.0%). A second nudge helped non-responders, but switching channels provided no extra benefit.
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.
Importance Statin nonadherence is a leading, addressable driver of preventable cardiovascular events. Although health systems routinely use outreach to promote preventive care, most strategies are static and lack evidence from randomized clinical trials. Objective To determine whether an adaptive, sequential digital outreach strategy improves short-term statin refill vs usual communication among adults with established atherosclerotic cardiovascular disease (ASCVD) or high ASCVD risk and recent nonadherence within a rapidly implemented, health system–embedded randomized clinical trial. Design, Setting, and Participants Pragmatic, health system–embedded, prospective randomized open blinded end point (PROBE) clinical trial using a 2-stage sequential, multiple assignment, randomized trial (SMART) design. The trial was conducted via Kaiser Permanente Northern California, an integrated health care delivery system serving more than 4.6 million members. Eligible participants were adults 18 years or older with established ASCVD or high ASCVD risk, recent statin nonadherence, and eligibility for all study communication modalities. Interventions Participants were randomized 1:1:1:1 to receive secure portal messaging, SMS/text messaging, nonsecure email, or usual communication. Initial nonresponders within 14 days underwent prespecified second-stage randomization to repeat the same outreach, switch communication modality, or receive usual communication. Main Outcomes and Measures Rates of 14-day statin refill following each randomization, with 28-day follow-up. Results Among 20 604 participants (mean [SD] age, 54.8 [9.0] years; 40.9% female; 27.8% Asian, 10.9% Black, 33.6% Hispanic; 15.3% with established ASCVD), initial digital outreach increased 14-day statin refill vs usual communication (14.4% vs 12.0%; adjusted risk difference, 2.3 percentage points [95% CI, 1.3-3.4]; adjusted risk ratio, 1.20 [95% CI, 1.10-1.30]). Among initial nonresponders, second-stage outreach further increased refill (13.0% vs 10.4%; adjusted risk difference, 2.5 percentage points [95% CI, 1.3-3.7]; adjusted risk ratio, 1.25 [95% CI, 1.11-1.39]). Switching communication modalities did not improve refill vs repeating the same modality (13.2% vs 12.5%; adjusted risk ratio, 1.06 [95% CI, 0.94-1.17]). Cumulative statin refill through 28 days was higher in those receiving any digital outreach vs usual communication (24.9% vs 21.2%; adjusted hazard ratio, 1.21 [95% CI, 1.13-1.30]). Results were consistent across prespecified subgroups. Conclusions and Relevance Among adults with a statin indication and recent statin nonadherence, adaptive outreach improved short-term refill vs usual communication. A second outreach produced additional gains among initial nonresponders, although switching communication modalities provided no additional benefit. These findings support adaptive, sequential health system outreach strategies to improve cardiovascular prevention when integrated into population health programs. Trial Registration ClinicalTrials.gov Identifier: NCT07522645
Journal, society, and media accounts. Useful signal, not independent expert judgment.
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 14-day statin refill (RR 1.20, 95% CI 1.10-1.30). Initial digital outreach increased 14-day statin refill compared with usual communication (14.4% vs 12.0%; RR 1.20; 95% CI 1.10-1.30).
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