Objectives: Patients vary in the degree to which they understand and engage in their health care. We hypothesized that a personalized patient health education tool will promote patient communication and align patient and provider treatment goals in follow-up visits in order to optimize guideline adherence, including evidence-based therapy use and cardiovascular risk factor control, after an acute myocardial infarction (AMI).
Methods: We developed a personalized patient education tool that summarized each patient’s status at discharge of secondary prevention risk factors (blood pressure (BP), low density lipoprotein cholesterol (LDL-C) and glycemic control), medication use (aspirin, beta blocker, ACE inhibitor/ARB, statin, P2Y12 inhibitor), and outpatient treatment goals. Patients were randomized 1:1 to usual care vs. receipt of the education tool within 2 weeks post-discharge (before the outpatient visit). We compared secondary prevention medication use, cardiovascular risk factor control, and awareness of treatment goals between randomized groups at 6 months post-discharge.
Results: Among 192 enrolled AMI patients, the median age was 60 years, 42% female, and 35% African American; demographic and clinical characteristics were well balanced between randomized groups. We noted high rates of secondary prevention therapy use at 6 months (Table). By 6 months post-discharge, mean systolic BP decreased by 10 mmHg with 80% of patients <140/90 mmHg, and mean LDL-C decreased by 13 mg/dl with 64% of patients under 100mg/dl. Overall, 36% of patients participated in cardiac rehabilitation. We observed no significant differences between randomized groups in any of these outcomes. Only 9% of patients who received the education tool brought it to their outpatient visit for discussion.
Conclusion: Though secondary prevention medication use remains reasonably high at 6 months, achievement of secondary prevention health goals remains suboptimal after a myocardial infarction. Few patients utilized the health tool in discussions with outpatient providers during their follow-up visit which likely explains the lack of outcomes differences between randomized groups. Further work is needed to find effective interventions to engage patients and promote sustained behavioral modification for secondary prevention.