Virtual Expert Patient Programme: can a video call increase long-term pharmacological adherence after a cardiovascular event?

Abstract Introduction Poor adherence is common and worsens long-term cardiovascular prognosis. The application of telemedicine and m-Health, especially text messaging, has been shown to be effective in improving adherence in patients with cardiovascular disease. However, there are no studies that indicate what possible role a digital intervention such as video-call with and expert patient during a cardiovascular hospital admission could have on long-term adherence. The first digital intervention in phase I of cardiac rehabilitation is presented: "Virtual Expert Patient Programme". Purpose The aim of this study was to assess the possible additional benefit of a digital intervention during hospital admission for a cardiovascular event with respect to drug adherence and major cardiovascular events at long-term follow-up. Methods A multicenter, non-blinded, randomised clinical trial was conducted in 319 patients who had completed a cardiac rehabilitation programme. Patients were randomised to use a mobile app (n=161) or routine follow-up (n=158). Survival analysis techniques using Kaplan Meier survival analysis and log-rank comparisons between groups were used to estimate treatment adherence outcomes as well as major cardiovascular events. Univariate analysis was performed for those who had undergone the ‘Virtual Expert Patient Programme’. Pharmacological adherence was determined by consulting the electronic pharmacological dispensation. Taking 80% of the prescribed medication per week was considered poor adherence. Results The study includes a total of 319 patients who completed the outpatient cardiac rehabilitation programme, of whom 55 had participated in the "Virtual Expert Patient Programme" (17,2%). The median follow-up of the study was 1.6 years. Patients who received the "Virtual Expert Patient Programme" care had lower medication discontinuation but with no statistically significant differences (HR 0.61; 95% CI 0.22-1.74; p= 0.357) (Figure 1). However, both groups had completed the outpatient cardiac rehabilitation programme and had good levels of medication adherence, which might have diminished the potential beneficial effect of the intervention. On the other hand, no differences were observed at follow-up with respect to major cardiovascular events (HR 0.93 95% CI 0.32-2.74; p= 0.898) (Figure 2). Conclusions The "Virtual Expert Patient Programme" is an easy and useful intervention that could improve long-term pharmacological adherence. Drug adherence after a cardiac rehabilitation programme is high. Larger studies should be conducted in order to assess the benefit of this intervention and especially in those who do not have access to an outpatient cardiac rehabilitation programme.Time to medication discontinuation Time to major cardiovascular events