The following is a summary of “Informational Postcards Improve Access To Remote Monitoring Among Veterans With Pacemakers And Implantable Cardioverter-Defibrillators: A Stepped-Wedge Randomized Controlled Trial,” published in the March 2023 issue of Cardiology by McLaughlin, et al.

Remote monitoring (RM) of pacemakers and implantable cardioverter-defibrillators (ICDs) is highly recommended as it reduces hospitalizations, ICD shocks, and death rates while improving patient quality of life. However, adherence to RM has been historically low, with only 60% of patients with cardiac devices being adherent. For a study, researchers tested the effect of informational postcards on improving adherence to RM.

A stepped-wedge randomized controlled trial (RCT) was conducted among all veteran patients with pacemakers/ICDs, followed by the Veterans Affairs National Cardiac Device Surveillance Program. Patients who had previously sent at least one remote transmission within the past 2 years but had become non-adherent were included. Non-adherent patients were defined as those who missed their last scheduled transmission by at least 10 days. Two informational postcards were designed: a “warning” postcard describing non-adherence risks to RM and an “encouraging” postcard that framed the same content with a positive/beneficial message. In the first step, patients were randomized to receive a postcard with either the two messages (warning vs. encouraging) or no postcard (control). In the second step, all patients received a postcard, again randomized to the two messages. Patients who did not send an RM transmission within 1 month were mailed a second, identical postcard in both steps. Using an intent-to-treat approach, the primary outcome was the proportion of patients who sent a transmission within ten weeks.

A total of 6,331 Veteran patients were randomized to receive a postcard (3,166 with warning messages and 3,165 with encouraging messages), and 2,400 were assigned to the control group (first step only). The mean age of the patients was 73 years. At 10 weeks, 2,974 patients (50%) who received a postcard sent a transmission, compared to 565 patients (24%) who did not receive a postcard (absolute difference 26%, P<0.001). Transmission rates did not significantly differ between patients randomized to the warning vs. encouraging message (50% vs. 49%, P=0.51). One-fourth of patients who sent a transmission did so only after the second postcard.

The study showed that informational postcards doubled the adherence to RM, and there was no difference between the two messaging strategies. These findings suggest that informational postcards could be a simple and effective method to improve adherence to RM in patients with cardiac devices.

Source: jacc.org/doi/10.1016/S0735-1097%2823%2900473-4