Extra reminders help, but statin refills still lag

Clinical takeaway: Expect most patients with recent statin nonadherence to remain that way after digital outreach. Reminders are worth sending, but they are a floor not a fix. 

Few gaps in cardiovascular prevention are as persistent as the one between statin prescriptions written and statins actually taken. Roughly 30 million US adults at high cardiovascular risk have an indication for the drugs, and nonadherence among them is common, contributing to avoidable heart attacks and strokes. 

Decades of interventions aimed at forgetfulness, out-of-pocket cost, and regimen complexity have produced inconsistent or incremental gains. Health systems now lean on digital channels instead, pushing refill prompts through patient portals, texts, and email, but most of these programs are static, one-time efforts that have rarely been tested in randomized trials. Whether such outreach changes refill behavior at all, which channels work best, and whether patients who ignore a first prompt can be recovered by a second have remained open questions. A large pragmatic randomized trial embedded in a health system's routine communication infrastructure has now put all three to a direct test, at a speed and scale few conventional trials manage. 

Patients sent any digital outreach refilled their statin within 14 days at a rate of 14.4%, versus 12.0% with usual communication. Usual communication already included the system's routine pharmacy refill reminders for most patients. That is an adjusted difference of 2.3 percentage points, a relative increase of about 20%. The overwhelming majority of patients did not respond. Even by 28 days, with many having received a second message, cumulative refill rate reached only 24.9% with outreach versus 21.2% without. 

Among patients who ignored the first message, a second one lifted 14-day refills to 13.0% versus 10.4% with no further study outreach. That gain of 2.5 adjusted percentage points matched the first-stage effect. Switching to a different channel added nothing over repeating the same one, 13.2% versus 12.5%, a difference compatible with chance. All three channels beat usual communication on the first pass, with secure portal messaging strongest at 14.9%, texts at 14.4%, and email at 13.9%. Effects held across subgroups including established cardiovascular disease versus high-risk status. 

The ADHERE-ASCVD trial randomized 20,604 Kaiser Permanente Northern California adults with established atherosclerotic cardiovascular disease or type 2 diabetes and recent statin nonadherence to portal message, text, email, or usual communication. Nonresponders at 14 days were rerandomized to a repeat message, a new channel, or nothing further. Medicare beneficiaries were excluded, and the outcome was refill, not ingestion. 

Follow-up continues through one year to see whether the refill gains last. The investigators also plan to tailor the timing, channel, and intensity of outreach to individual patients. The accompanying editorial highlights a different legacy: the trial went from protocol to results in under 60 days using the health system's existing infrastructure, a model other systems could copy to test fixes for their own care gaps. And for patients no reminder reaches, the editorial argues the better answer may be long-acting therapies such as twice-yearly inclisiran. 

"It remains uncertain whether any low-intensity outreach strategy, be it phone calls, messages, or additional forms of communication, can produce durable improvements among the large proportion of high-risk patients who remain nonadherent," writes Luke J. Laffin, MD, preventive cardiologist at Cleveland Clinic, in an accompanying editorial. 

Source: Bhatt AS, et al. (2026 Aug 29) JAMA. Digital Outreach to Improve Statin Refills in Patients With Low Statin Adherence: The ADHERE-ASCVD Randomized Clinical Trial