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Krackhardt F, Jörnten-Karlsson M, Waliszewski M, Knutsson M, Niklasson A, Appel KF, Degenhardt R, Ghanem A, Köhler T, Ohlow MA, Tschöpe C, Theres H, Vom Dahl J, Karlson BW, Maier LS. Results from the "Me & My Heart" (eMocial) Study: a Randomized Evaluation of a New Smartphone-Based Support Tool to Increase Therapy Adherence of Patients with Acute Coronary Syndrome. Cardiovasc Drugs Ther 2023; 37:729-741. [PMID: 35441926 PMCID: PMC10397150 DOI: 10.1007/s10557-022-07331-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study evaluated whether patient support, administered via an electronic device-based app, increased adherence to treatment and lifestyle changes in patients with acute coronary syndrome (ACS) treated with ticagrelor in routine clinical practice. METHODS Patients (aged ≥ 18 years) with diagnosed ACS treated with ticagrelor co-administered with low-dose acetylsalicylic acid were randomized into an active group (with support tool app for medication intake reminders and motivational messages) and a control group (without support tool app), and observed for 48 weeks (ClinicalTrials.gov Identifier: NCT02615704). Patients were asked to complete the 36-item Short-Form Health Survey (SF-36) and Lifestyle Changes Questionnaire (LSQ), and were assessed for blood pressure and body mass index (BMI) at baseline (visit 1) and at the end of the study (visit 2). Medication adherence was measured using the Brilique Adherence Questionnaire (BAQ). RESULTS Patients (N = 676) were randomized to an active (n = 342) or a control (n = 334) group. BAQ data were available for 174 patients in the active group and 174 patients in the control group. Over the 48-week period, mean (standard deviation) adherence for the active and control groups was 96.4% (13.2%) and 91.5% (23.1%), respectively (effect of app intervention, p < 0.05). There were no significant differences in blood pressure and BMI between visits. General improvements in SF-36 and LSQ scores were observed for both groups. CONCLUSION The patient support tool app was associated with significant improvements in patient-reported treatment adherence compared with a data collection app alone in patients prescribed ticagrelor for ACS.
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Affiliation(s)
- Florian Krackhardt
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | | | - Matthias Waliszewski
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Mikael Knutsson
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Niklasson
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | | | | | - Till Köhler
- Herzzentrum Wuppertal, Helios-Universitätsklinikum, Wuppertal, Germany
| | | | - Carsten Tschöpe
- Berlin Institute of Health at Charité; BIH Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Björn W Karlson
- Late Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars S Maier
- Department of Internal Medicine II, Universitätsklinikum Regensburg, Regensburg, Germany
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Praus F, Krzowski B, Walther T, Gratzke C, Balsam P, Miernik A, Pohlmann PF. Smartphone applications managing antithrombotic therapy: a scoping literature review (Preprint). JMIR Cardio 2021; 6:e29481. [PMID: 35727608 PMCID: PMC9257616 DOI: 10.2196/29481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/16/2021] [Accepted: 03/30/2022] [Indexed: 11/18/2022] Open
Abstract
Background Antithrombotic therapy is complex and requires informed decisions and high therapy adherence. Several mobile phone apps exist to either support physicians in the management of antithrombotic therapies or to educate and support patients. For the majority of these apps, both their medical evidence and their development background are unknown. Objective This review aims to investigate the available literature describing high-quality apps for managing antithrombotic therapy based on professional scientific information. Methods Keywords and Medical Subject Heading terms were used to search MEDLINE via PubMed and Ovid between December 2019 and January 2022. Inclusion criteria were the availability of full text and publications in the English language. Apps that solely focused on atrial fibrillation were excluded. Qualitative findings were thematically synthesized and reported narratively. Results Out of 149 identified records, 32 were classified as eligible. We identified four groups: (1) apps for patients supporting self-management of vitamin K antagonists, (2) apps for patients increasing therapy adherence, (3) educational apps for patients, and (4) apps for physicians in supporting guideline adherence. Conclusions Throughout the evaluated data, patients from all age groups receiving antithrombotic drugs expressed the desire for a digital tool that could support their therapy management. In addition, physicians using mobile guideline-based apps may have contributed to decreased adverse event rates among their patients. In general, digital apps encompassing both user-friendly designs and scientific backgrounds may enhance the safety of antithrombotic therapies. However, our evaluation did not identify any apps that addressed all antithrombotic drugs in combination with perioperative stratification strategies. Currently, strict regulations for smartphone apps seem to negatively affect the development of new apps. Therefore, new legal policies for medical digital apps are urgently needed.
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Affiliation(s)
- Friederike Praus
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Bartosz Krzowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Tabea Walther
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Paweł Balsam
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Philippe Fabian Pohlmann
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
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Krackhardt F, Maier LS, Appel KF, Köhler T, Ghanem A, Tschoepe C, Dahl JV, Degenhardt R, Niklasson A, Ahlqvist M, Waliszewski MW, Jörnten-Karlsson M. Design and rationale for the "Me & My Heart" (eMocial) study: A randomized evaluation of a new smartphone-based support tool to increase therapy adherence of patients with acute coronary syndrome. Clin Cardiol 2019; 42:1054-1062. [PMID: 31490566 PMCID: PMC6837026 DOI: 10.1002/clc.23254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 12/03/2022] Open
Abstract
A novel smartphone‐based patient support tool was developed to increase the adherence to antiplatelet therapy and lifestyle changes in patients after coronary angioplasty for acute coronary syndrome (ACS). The eMocial study (http://clinicaltrials.gov Identifier: NCT02615704) investigates whether an electronic support tool will improve adherence to comedication and lifestyle changes in ACS patients. The primary hypothesis of this trial is that an electronic support tool can increase adherence to comedication (primary endpoint) thereby supporting positive lifestyle changes (secondary endpoints). Patients hospitalized with ACS (ST elevation myocardial infarction [STEMI], non‐ST elevation myocardial infarction [NSTEMI], or unstable angina pectoris) and treated with ticagrelor coadministered with low‐dose acetylsalicylic acid will be randomized 1:1 to an active group receiving the patient support tool via a smartphone‐based application or to a control group without the patient support tool. Patient questionnaires to evaluate lifestyle changes and quality of life will be used at baseline and at the end of the 48‐week observation phase. Patients are asked to fill out questionnaires to determine their adherence, treatment attitudes, health‐care utilization and risk factors on a monthly basis. The study was started in February 2016 and the completion date is scheduled for October 2019. For final analysis 664 patients are expected be available. Preliminary baseline demographics were unstable angina pectoris (13.7%), NSTEMI (49.9%), STEMI (36.4%), male gender (86.3%), and diabetes mellitus (17.6%). Our study could significantly help to understand how inadequate adherence to antiplatelet therapy in ACS patients could be improved with a smartphone‐based application.
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Affiliation(s)
- Florian Krackhardt
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Charité University Medicine Berlin, Berlin, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | | | - Till Köhler
- Universitätslinikum Wuppertal, Wupperthal, Germany
| | | | - Carsten Tschoepe
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Charité University Medicine Berlin, Berlin, Germany
| | - Jürgen Vom Dahl
- Kliniken Maria Hilf GmbH/Medizinische Klinik II, Mönchengladbach, Germany
| | - Ralf Degenhardt
- Institut für Klinische Forschung Herz- und Kreislaufzentrum GmbH, Fulda, Germany
| | | | | | - Matthias W Waliszewski
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Charité University Medicine Berlin, Berlin, Germany
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