Email ‘nudges’ highlighting flu vaccine’s heart benefits improve uptake
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Key takeaways:
- Electronic nudges promoting influenza vaccination improved vaccine uptake for older and younger adults in Denmark.
- Adults with acute MI history and those who may be vaccine-hesitant showed more improved uptake.
CHICAGO — Emailed messages emphasizing the CV benefits of influenza vaccination improved vaccine uptake among older and younger adults in Denmark, particularly among more vulnerable patients with a history of acute MI, researchers reported.
Data from a pooled analysis of three randomized controlled trials also showed that among the subset of patients with acute MI, the email “nudge” strategy had greater benefits for some with recent acute MI and those not vaccinated during the previous influenza season, perhaps due to vaccine hesitancy.
“If validated, a CV-focused messaging strategy should be employed as a simple, scalable and effective tool to improve vaccination rates among high-risk patients with a history of acute MI,” Ankeet S. Bhatt, MD, MBA, ScM, a cardiologist at Kaiser Permanente San Francisco Medical Center, a research scientist at the Kaiser Permanente Northern California Division of Research and an adjunct professor at the Stanford University School of Medicine in Palo Alto, California, said during a press conference at the American Heart Association Scientific Sessions.
Influenza increases risk for CV events, including MI, Bhatt said during a presentation, and data suggest influenza vaccines reduce risk for major adverse CV events. Despite this, vaccination rates remain suboptimal among people with acute MI.
Letters highlighting vaccine benefits
Researchers conducted NUDGE-FLU, including adults aged 65 years and older (n = 964,870), NUDGE-FLU-2, also including older adults (n = 881,373) and NUDGE-FLU-CHRONIC, which included adults aged 18 to 64 years with a chronic condition (n = 299,881). The three trials took place during the 2022-2023 and 2023-2023 influenza seasons in Denmark, where influenza vaccinations are available for free. Across studies, mean age was 71.1 years; 51.9% were women; and 59,458 participants (2.8%) had a history of acute MI.
Participants were randomly assigned to usual care or various behaviorally informed electronically delivered letter-based nudges. In a participant-level pooled meta-analysis, researchers assessed the interaction of acute MI status on the effects of the letter-based nudges vs. usual care.
The pooled findings were simultaneously published in JAMA Cardiology.
Researchers found improvement in vaccine uptake was similar among adults regardless of acute MI history who received any nudge letter compared with usual care (+1.81 vs. +1.32 percentage points; P for interaction by acute MI status = .09).
A letter highlighting CV benefits of vaccination was associated with greater improvements in vaccine uptake among patients with acute MI history compared with those with no history (+3.91 vs +2.03 percentage points; P for interaction by acute MI status = .002).
In subanalyses of participants with acute MI history only, the benefits of the letter that specifically highlighted the CV benefits of vaccination were more pronounced among those who were not vaccinated during the prior influenza season (+13.7 vs +1.48 percentage points; P for interaction < .001), Bhatt said.
Among younger participants with chronic disease, the letter highlighting CV benefits was even more effective among those with a more recent acute MI (P for interaction by continuous recency of acute MI < .001).
Best message for ‘unsure,’ high-risk group
In a discussant presentation, Orly Vardeny, PharmD, MS, associate professor of medicine at the University of Minnesota, said CDC data show more than 90% of people hospitalized for influenza in the United States had at least one underlying medical condition; nearly 50% had CVD.
Implementation can be most impactful among the vaccine-hesitant, Vardeny said.
“In this important study, the NUDGE-FLU program taught us what message will resonate with an unsure, high-risk group with a history of MI who are at greatest risk for influenza complications,” Vardeny said. “We learned that a letter that describes the potential heart benefits of influenza vaccination beyond preventing flu is most effective. Importantly, this message worked in people who were not vaccinated in the prior year — those in the ‘unsure’ group or perhaps a few in the ‘definitely not getting vaccinated’ group. This is important to change their minds to get this important therapy.”
References:
- Bhatt AS, et al. JAMA Cardiol. 2024;doi:10.1001/jamacardio.2024.4648.
- Madjid M, et al. JAMA Cardiol. 2024;doi:10.1001/jamacardio.2024.4692.
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Bhatt AS, et al. LBS.05. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2024; Chicago.
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