Postcard reminders may improve remote cardiac monitoring

Mailed reminders may help increase adherence to remote monitoring in patients with pacemakers and implantable cardioverter-defibrillators (ICDs), a study found.

Researchers performed a stepped-wedge randomized controlled trial to determine whether informational postcards affected adherence to remote cardiac monitoring. In the first wave of the trial, U.S. veterans with pacemakers and ICDs who had sent at least one remote monitoring transmission but had then become nonadherent were randomly assigned to receive a postcard or not. Those in the postcard group were then further randomly assigned to receive a “warning” message that described the risks of nonadherence or an “encouraging” message describing the benefits of adherence.

In the trial's second wave, those who had not received a postcard in the first wave or had become nonadherent since then were randomly assigned to receive a postcard with one of the two messages. Any patient who received a postcard and didn't send a remote monitoring transmission within a month received a second identical postcard. The primary outcome was adherence to remote monitoring, which was defined as sending a transmission within 70 days of each wave's initial postcard mailing. The study results were published Jan. 22 by the Journal of General Internal Medicine.

Of the 6,351 patients who made up the overall study population, the mean age was 70.8 years, 97.6% were men, and 74.5% were White. The first wave of the trial included 4,362 patients, 2,184 who were mailed postcards and 2,178 controls. Of the 2,184 who received postcards in this wave, 1,098 received warning messages and 1,086 received encouraging messages, with 785 and 760, respectively, receiving a second postcard after not responding. The second wave included 1,484 controls from the first wave and 1,989 additional patients who met the trial criteria. Of these 3,473 patients, 1,723 received warning postcards and 1,750 received encouraging postcards, with 1,115 and 1,221, respectively, receiving a second postcard after not responding.

Of the 5,657 patients who received at least one postcard during the trial, 48.7% sent a remote monitoring transmission within 70 days versus 24.3% of controls (absolute difference, 24.4%; 95% CI, 22.2% to 26.6%). Overall, 71.8% of those who sent a transmission did so after the first postcard. There was no significant difference in transmission rates at 70 days between those who received warning versus encouraging messages (odds ratio, 1.04; 95% CI, 0.92 to 1.18).

Among other limitations, the study included mostly White men and took place during the COVID-19 pandemic, which emphasized remote care, the authors noted. They concluded that informational postcards significantly improved adherence to remote monitoring among U.S. veterans with pacemakers and ICDs. “This simple intervention could improve access to [remote monitoring] care and has potential to improve clinical outcomes,” the authors wrote. They called for future studies to evaluate which patients didn't respond to the postcards and why, as well as to determine the best combination of digital and mailed reminders.