National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100073, China.
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100073, China.
Chin Med J (Engl). 2018 Jun 20;131(12):1480-1489. doi: 10.4103/0366-6999.233767.
Secondary preventive therapies play a key role in the prevention of adverse outcomes after coronary artery bypass grafting (CABG). However, medication adherence after CABG is often poor, and conventional interventions for improving adherence have limited success. With increasing penetration of smartphones, health-related smartphone applications might provide an opportunity to improve adherence. Carefully designed trials are needed to provide reliable evidence for the use of these applications in patients after CABG.
The Measurement and Improvement Studies of Surgical Coronary Revascularization: Medication Adherence (MISSION-2) study is a multicenter randomized controlled trial, aiming to randomize 1000 CABG patients to the intervention or control groups in a 1:1 ratio. We developed the multifaceted, patient-centered, smartphone-based Heart Health Application to encourage medication adherence in the intervention group through a health self-management program initiated during hospital admission for CABG. The application integrated daily scheduled reminders to take the discharge medications, cardiac educational materials, a dynamic dashboard to review cardiovascular risk factors and secondary prevention targets, and weekly questionnaires with interactive feedback. The primary outcome was secondary preventive medication adherence measured by the Chinese version of the 8-item Morisky Medication Adherence Scale at 6 months after randomization. Secondary outcomes included all-cause death, cardiovascular rehospitalization, and a composite of death, myocardial infarction, stroke, and repeat revascularization.
Findings will not only provide evidence regarding the feasibility and effectiveness of the described intervention for improving adherence to CABG secondary preventive therapies but also explore a model for outpatient health self-management that could be translated to various chronic diseases and widely disseminated across resource-limited settings.
https://clinicaltrials.gov (NCT02432469).
二级预防疗法在预防冠状动脉旁路移植术后（CABG）不良结局方面发挥着关键作用。然而，CABG 后的药物依从性往往较差，传统的改善依从性的干预措施收效有限。随着智能手机的普及，与健康相关的智能手机应用程序可能为改善依从性提供机会。需要精心设计的试验来为这些应用程序在 CABG 后患者中的使用提供可靠的证据。
外科冠状动脉血运重建术的测量和改进研究：药物依从性（MISSION-2）研究是一项多中心随机对照试验，旨在将 1000 例 CABG 患者以 1:1 的比例随机分为干预组和对照组。我们开发了一种多方面的、以患者为中心的基于智能手机的心脏健康应用程序，通过在 CABG 住院期间启动的健康自我管理计划，鼓励干预组的药物依从性。该应用程序集成了每日定时提醒服用出院药物、心脏教育材料、一个动态仪表板，用于查看心血管危险因素和二级预防目标，以及每周带有互动反馈的问卷。主要结局是在随机分组后 6 个月时用中文版 8 项 Morisky 药物依从性量表测量的二级预防药物依从性。次要结局包括全因死亡、心血管再住院、死亡、心肌梗死、卒中和再次血运重建的复合终点。
研究结果不仅将提供关于描述的干预措施提高 CABG 二级预防治疗依从性的可行性和有效性的证据，还将探索一种门诊健康自我管理模式，可以转化为各种慢性病，并在资源有限的环境中广泛传播。
