Effect of a Smartphone-Based Intervention on Secondary Prevention Medication Prescriptions After Coronary Artery Bypass Graft Surgery: The MISSION-1 Randomized Controlled Trial.

Abstract

BACKGROUND\nStudies found that patients who underwent coronary artery bypass grafting (CABG) often fail to receive optimal evidence-based secondary prevention medications. We evaluated the effectiveness of a smartphone-based quality improvement effort on improving prescription of medical therapies.\n\n\nMETHODS\nIn this cluster-randomized controlled trial, 60 hospitals were randomized to a control arm (n=30) or to an intervention arm using smartphone-based multifaceted quality improvement interventions (n=30). The primary outcome was prescription of statin. The secondary outcomes were prescription of beta-blocker, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACE inhibitor or ARB), and optimal medical therapy for eligible patients.\n\n\nRESULTS\nBetween June 1, 2015 and September 15, 2016, a total of 10006 CABG patients were enrolled (5653 in 26 intervention and 4353 in 29 control hospitals, five hospitals withdrew). Statin prescribing rate was 87.8% in the intervention arm and 84.4% in the control arm. We saw no evidence of an effect of intervention on statin prescribing in the intention-to-treat analysis (odds ratio, 1.31; 95% confidence interval, 0.68 to 2.54; P=0.43) or in key patient subsets. The prescription rates of ACE inhibitor or ARB and optimal medical therapy were comparable between study groups, while beta-blocker was more often prescribed in the intervention arm. Post hoc analysis demonstrated a greater increase in statin prescribing rate over time in the intervention arm.\n\n\nCONCLUSIONS\nA smartphone-based quality improvement intervention compared with usual care did not increase statin prescribing for patients who received CABG. New studies focusing on the best practice of this technique may be warranted.\n\n\nCLINICAL TRIAL REGISTRATION\nhttps://www.clinicaltrials.gov (NCT02430012).