Effect Of A Tertiary A-level Hospital WeChat-Based Intervention On Medication Adherence And Risk Factor Control In Patients With Stable Coronary Artery Disease Compared With Traditional Community Hospital Follow-Up: A Multicenter, Prospective Study (Preprint)

BACKGROUND In China, the main cause of mortality is a cardiac condition known as ischemic heart disease. Having cardiac rehabilitation and a secondary prevention program in place is a class IA recommendation for individuals with coronary artery disease. WeChat-based interventions seem to be feasible and efficient for the follow-up and management of chronic diseases. OBJECTIVE This study aimed to evaluate the effectiveness of a tertiary A-level hospital WeChat-based telemedicine in comparison with a conventional community hospital follow-up on medication adherence and risk factor control in individuals suffering stable coronary artery disease. METHODS In this multicenter, prospective study, 1,424 patients with stable coronary artery disease in Beijing, China, were consecutively enrolled between September 2018 and September 2019 from the Fuwai Hospital and 4 community hospitals. At the 1-month, 3-month, 6-month, and 12-month follow-ups, participants received healthy lifestyle recommendations and medication advice. Following that, the control group went to an offline outpatient clinic at four separate community hospitals. the intervention group had follow-up visits through WeChat-based telemedicine management. The main endpoint was the medication adherence, which was defined as the participant compliance in taking all four cardioprotective medications that would improve the patient's outcome (therapies included antiplatelet therapy, β-blockers, statins, and angiotensin-converting-enzyme inhibitor or angiotensin-receptor blocker). Multivariable generalized estimating equations were used when comparing the primary and secondary outcomes between the two groups and calculating the relative risk at 12 months. Propensity score matching and inverse probability of treatment weighting were performed as sensitivity analyses, and the propensity scores were calculated by a multivariable logistic regression model. RESULTS At 1 year, 88.0% [565/642] patients in the intervention group and 91.8% [518/564] patients in the control group had successful followed-up data. We matched 257 pairs of patients between the intervention group and the control group. There was no obvious advantage in the medication adherence with the 4 cardioprotective drugs in the intervention group (30.4% [172/565] vs. 27.4% [142/518], RR 0.99, 95% CI: 0.97-1.02, P=.648). The intervention measures improved the smoking cessation (7.8% [44/565] vs. 22.8% [118/518], RR 0.48, 95% CI: 0.44-0.53, P<.001), alcohol restriction (5.8% [33/565] vs. 17.6% [91/518], RR 0.47, 95% CI: 0.42-0.54, P<.001). CONCLUSIONS Tertiary A-level hospital WeChat-based intervention did not improve the adherence to the four cardioprotective medications compared to the traditional method. Tertiary A-level hospital WeChat-based intervention has a positive effect on improving lifestyle, such as quitting drinking and smoking, in patients with stable coronary artery disease and can be tried as a supplement to community hospital follow-up. CLINICALTRIAL ClinicalTrials.gov NCT04795505; https://clinicaltrials.gov/ct2/show/NCT04795505.