Effect of nurse-led telephone follow-up to optimize adherence to preventive medication after screen-detected cardiovascular disease: A randomized controlled trial.
Helen Gräs Højgaard, Annette Langager Høgh, Jes S Lindholt, Kirsten Frederiksen, Marie Dahl
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Abstract
Aims: To investigate the effect of nurse-led telephone follow-up (TFU) on medication adherence after screen-detected cardiovascular disease (CVD).
Methods: We conducted a randomized controlled trial evaluating the effect on adherence of nurse-led TFU at 1, 3, and 6 months, compared to usual care. The primary outcome was medication adherence after one year. Secondary outcomes were quarterly point prevalence time after the recommendation. Participants, aged 67 years, were recruited from the Danish Viborg Screening Programme (VISP) cohort between May 2017 and April 2022. Participants (n = 406) with screen-detected abdominal aortic aneurysm, peripheral arterial disease, and/or carotid plaque and recommended anti-platelets and/or lipid-lowering therapy were randomized 1:1 to intervention (n = 202) or control group (n = 204). The intention-to-treat principle was applied. Pearson's χ² and logistic regression analysis were used.
Results: We found no significant inter-group differences concerning medication adherence after one year. Anti-platelet adherence was 59% in the intervention group; 62%, in the control group. Lipid-lowering medication adherence was 70% in both groups. Adjusted analysis showed no intervention effect for lipid-lowering medication (OR: 1.06, 95% CI: 0.69-1.63, p = 0.800) or anti-platelets (OR: 0.93, 95% CI: 0.62-1.39, p = 0.732). No group differences were observed at point prevalence time. We found no association between sex, marital status, occupation, education, smoking, comorbidities, medication use, and adherence after one year.
Conclusion: Nurse-led TFU did not improve CVD preventive medication adherence compared with usual care; facilitating adherence may require more than phone calls. Further research is needed to tailor interventions to individual adherence barriers.
Registration: The study is nested within the VISP study in ClinicalTrials.gov (NCT03395509).
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