Effect of Electronic Reminders, Financial Incentives, and Social Support on Outcomes After Myocardial Infarction - HeartStrong

Contribution To Literature:

The HeartStrong trial failed to show that a system of medication reminders prevented vascular events.


The goal of the trial was to evaluate a system of medication reminders compared with usual care among patients who suffered an acute myocardial infarction (AMI). The intervention included use of electronic pill bottles combined with lottery incentives and social support for medication adherence.

Study Design

  • Randomized
  • Parallel

Patients who suffered an AMI were randomized to a system of medication reminders (n = 1,003) versus usual care (n = 506).

  • Total number of enrollees: 1,509
  • Duration of follow-up: 12 months
  • Mean patient age: 61 years
  • Percentage female: 36%

Inclusion criteria:

  • Patients who suffered an AMI
  • Currently prescribed at least two of four study medications (statin, aspirin, beta-blocker, antiplatelet agent)
  • Hospitalized for 1-180 days and discharged home with a principal diagnosis of AMI

Exclusion criteria:

  • Metastatic cancer
  • End-stage renal disease
  • Dementia

Principal Findings:

The primary outcome, incidence of death, MI, stroke, unstable angina, or congestive heart failure, was similar between the intervention and control groups (hazard ratio, 0.93; p = 0.70). There was no difference in any of the tested subgroups.


Among patients who suffered an AMI, a system of medication reminders was not superior to preventing vascular events compared with usual care.


Volpp KG, Troxel AB, Mehta SJ, et al. Effect of electronic reminders, financial incentives, and social support on outcomes after myocardial infarction: The HeartStrong randomized clinical trial. JAMA Intern Med 2017;Jun 26:[Epub ahead of print].

Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Nonstatins, Novel Agents, Statins, Acute Heart Failure

Keywords: Adrenergic beta-Antagonists, Acute Coronary Syndrome, Angina, Unstable, Aspirin, Heart Failure, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medication Adherence, Myocardial Infarction, Outcome Assessment (Health Care), Platelet Aggregation Inhibitors, Primary Prevention, Social Support, Stroke, Vascular Diseases

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