JMIR Publications

ABSTRACT

Background:

A lifesaving treatment for myocardial infarction is the placement of a stent in a closed or obstructed coronary artery. The largest modifiable risk factor after receiving a stent is medication adherence to Dual AntiPlatelet Therapy (DAPT), a combination of P2Y12 inhibitors and aspirin.

Objective:

To determine the acceptability of the protocol and intervention of MyIDEA with secondary aims on medications adherence via prescription days covered (PDC) and platelet activation tests in a multisite randomized control trial.

Methods:

Potential participants who received a Post Percutaneous Coronary Intervention (PCI) procedure with a drug eluting stent (DES) were approached. All patients > 50 and spoke English were recruited. participants were recruited and baseline demographics and the Hospital Anxiety and Depression Scale (HADS), Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF), Burden-Benefit questionnaire, 36-Item Short Form Health Survey (SF-36), and PCI knowledge questionnaire were administered. Block randomization randomized participants to either usual care or My Interventional DES Educational App (MyIDEA) supplementation. MyIDEA is a personalized educational intervention based on Kolb learning experiential theory using patient narratives for education. Participants had blood drawn to measure platelet suppression from medication at the visits. During the second and third encounters, the Morisky medication adherence score and cardiology outcomes were measured. The study was conducted at the University of Illinois Hospital and John H. Stroger Jr. Cook County Hospital with appropriate ethical approvals. Platelet suppression was measured through aspirin reactive units (ARUs) and P2Y12 reactive units (PRU). Medication adherence was measured using the proportion of days covered (PDC). The analysis team was blinded to the participants’ group membership. The primary outcome was feasibility analysis of recruitment and retention.

Results:

The mean age of participants was 60.4 ± 7.1; the majority of patients were Black and non- Hispanic. The majority of patients’ reading levels were 7th grade or above and were not as familiar with other electronic devices for information and communication. The number of control subjects was 21 and interventional arms was 24. The interventional group was able to use the MyIDEA in both the hospital and outpatient setting. However, there was no significant difference in platelet suppression or medication adherence between groups. There were also differences between the groups in depression and anxiety initially as measures by the HADS. No documented adverse event associated with the intervention was found.

Conclusions:

Elderly patients are willing to use tablet devices to increase education about health conditions. Additional studies are required to measure the effectiveness and determining the most suitable timing and location for patient education.