Comparing the Efficacy of Targeted and Blast Portal Messaging in Message Opening Rate and Anticoagulation Initiation in Patients With Atrial Fibrillation in the Preventing Preventable Strokes Study II: Prospective Cohort Study

Alok Kapoor; Parth Patel; Soumya Chennupati; Daniel Mbusa; Hammad Sadiq; Sanjeev Rampam; Robert Leung; Megan Miller; Kevin Rivera Vargas; Patrick Fry; Mary Martin Lowe; Christina Catalano; Charles Harrison; John Nicholas Catanzaro; Sybil Crawford; Anne Marie Smith

doi:10.2196/49590

Comparing the Efficacy of Targeted and Blast Portal Messaging in Message Opening Rate and Anticoagulation Initiation in Patients With Atrial Fibrillation in the Preventing Preventable Strokes Study II: Prospective Cohort Study

JMIR Cardio. 2024 Jan 24:8:e49590. doi: 10.2196/49590.

Authors

Alok Kapoor^{1

2}, Parth Patel¹, Soumya Chennupati¹, Daniel Mbusa¹, Hammad Sadiq¹, Sanjeev Rampam¹, Robert Leung^{1

2}, Megan Miller³, Kevin Rivera Vargas³, Patrick Fry⁴, Mary Martin Lowe⁵, Christina Catalano⁴, Charles Harrison⁴, John Nicholas Catanzaro⁴, Sybil Crawford¹, Anne Marie Smith⁶

Affiliations

¹ University of Massachusetts Chan Medical School, Worcester, MA, United States.
² University of Massachusetts Memorial Health Care, Worcester, MA, United States.
³ College of Pharmacy, University of Florida, Jacksonville, FL, United States.
⁴ College of Medicine, University of Florida, Jacksonville, FL, United States.
⁵ Learning Advisors LLC, Chicago, IL, United States.
⁶ Heart Rhythm Society, Washington, DC, United States.

PMID: 38265849
PMCID: PMC10851125
DOI: 10.2196/49590

Abstract

Background: The gap in anticoagulation use among patients with atrial fibrillation (AF) is a major public health threat. Inadequate patient education contributes to this gap. Patient portal-based messaging linked to educational materials may help bridge this gap, but the most effective messaging approach is unknown.

Objective: This study aims to compare the responsiveness of patients with AF to an AF or anticoagulation educational message between 2 portal messaging approaches: sending messages targeted at patients with upcoming outpatient appointments 1 week before their scheduled appointment (targeted) versus sending messages to all eligible patients in 1 blast, regardless of appointment scheduling status (blast), at 2 different health systems: the University of Massachusetts Chan Medical School (UMass) and the University of Florida College of Medicine-Jacksonville (UFL).

Methods: Using the 2 approaches, we sent patient portal messages to patients with AF and grouped patients by high-risk patients on anticoagulation (group 1), high-risk patients off anticoagulation (group 2), and low-risk patients who may become eligible for anticoagulation in the future (group 3). Risk was classified based on the congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age between 65 and 74 years, and sex category (CHA₂DS₂-VASc) score. The messages contained a link to the Upbeat website of the Heart Rhythm Society, which displays print and video materials about AF and anticoagulation. We then tracked message opening, review of the website, anticoagulation use, and administered patient surveys across messaging approaches and sites using Epic Systems (Epic Systems Corporation) electronic health record data and Google website traffic analytics. We then conducted chi-square tests to compare potential differences in the proportion of patients opening messages and other evaluation metrics, adjusting for potential confounders. All statistical analyses were performed in SAS (version 9.4; SAS Institute).

Results: We sent 1686 targeted messages and 1450 blast messages. Message opening was significantly higher with the targeted approach for patients on anticoagulation (723/1156, 62.5% vs 382/668, 57.2%; P=.005) and trended the same in patients off anticoagulation; subsequent website reviews did not differ by messaging approach. More patients off anticoagulation at baseline started anticoagulation with the targeted approach than the blast approach (adjusted percentage 9.3% vs 2.1%; P<.001).

Conclusions: Patients were more responsive in terms of message opening and subsequent anticoagulation initiation with the targeted approach.

Keywords: anticoagulants; atrial fibrillation; humans; outpatients; patient education as topic; patient portals.

©Alok Kapoor, Parth Patel, Soumya Chennupati, Daniel Mbusa, Hammad Sadiq, Sanjeev Rampam, Robert Leung, Megan Miller, Kevin Rivera Vargas, Patrick Fry, Mary Martin Lowe, Christina Catalano, Charles Harrison, John Nicholas Catanzaro, Sybil Crawford, Anne Marie Smith. Originally published in JMIR Cardio (https://cardio.jmir.org), 24.01.2024.