Digital Outreach Boosts Statin Adherence in High-Risk Patients

Digital outreach strategies significantly improve statin refill rates among patients with established atherosclerotic cardiovascular disease or high cardiovascular risk, according to a randomized clinical trial published on August 29, 2026, in JAMA. Researchers found that automated messaging via patient portals, text messages, and emails successfully prompted patients with recent statin nonadherence to pick up their medications compared to usual communication methods.

The pragmatic, health system-embedded study, known as the ADHERE-ASCVD trial, evaluated 20,604 participants within Kaiser Permanente Northern California, an integrated health care delivery system. According to the study data, the participants had a mean age of 54.8 years, and the cohort included 40.9 percent female patients, 27.8 percent Asian patients, 10.9 percent Black patients, 33.6 percent Hispanic patients, and 15.3 percent with established atherosclerotic cardiovascular disease.

Evaluating Initial Digital Outreach vs Usual Communication

Initial digital outreach increased 14-day statin refill rates compared to usual communication, achieving a 14.4 percent refill rate versus 12.0 percent. This translated to an adjusted risk difference of 2.3 percentage points and an adjusted risk ratio of 1.20, according to the published findings.

Participants in the trial were randomized in a 1:1:1:1 ratio to receive secure portal messaging, SMS text messaging, nonsecure email, or standard communication. The trial design utilized a two-stage sequential, multiple assignment, randomized trial framework to test adaptive communication strategies.

Second-Stage Outreach and Cumulative Refill Outcomes

For initial nonresponders within a 14-day window, researchers administered a prespecified second-stage randomization. Patients either repeated the same outreach modality, switched to a different communication modality, or received usual communication.

Second-stage outreach further increased refill rates among initial nonresponders, reaching 13.0 percent compared to 10.4 percent for usual communication. This yielded an adjusted risk difference of 2.5 percentage points and an adjusted risk ratio of 1.25. However, switching communication modalities did not improve refills compared to repeating the same modality, showing an adjusted risk ratio of 1.06.

Overall, cumulative statin refill rates through a 28-day follow-up period were higher in patients receiving any digital outreach compared to usual communication, hitting 24.9 percent versus 21.2 percent with an adjusted hazard ratio of 1.21. Study authors noted that these results remained consistent across all prespecified patient subgroups.