ADHERE-ASCVD: Digital Reminders Improve Refill Rates, Adherence to Statins in ASCVD

According to data from the ADHERE-ASCVD trial, adaptive digital outreach via texts, emails, and secure portal messaging can improve short-term statin refill in patients with or at high risk of atherosclerotic cardiovascular disease (ASCVD).^1,2

These data, presented at the European Society of Cardiology (ESC) Congress 2026 in Munich, Germany, by Ankeet Bhatt, MD, MBA, cardiologist and investigator at Kaiser Permanente and adjunct professor at the Stanford University School of Medicine, represent a substantial step forward in addressing nonadherence, which is among the leading causes of preventable cardiovascular events.²

“We essentially did this with very little to no funding, utilizing routine health system workflows, and we were able to conduct this study within 60 days from protocol finalization to trial readout,” Bhatt told HCPLive in an exclusive interview. “I think that, in the context of an intervention that is basically free and systems already have the existing infrastructure and technology to deploy them, we were encouraged by our findings.”

ADHERE-ASCVD Structure

ADHERE-ASCVD was a prospective, randomized, open-label, blinded endpoint trial aiming to evaluate and optimize patient-facing messaging strategies for statin refill and adherence. Bhatt and colleagues included patients ≥18 years within the Kaiser Permanente Northern California health system who had ASCVD or diabetes. Additionally, patients were required to have no statin prescription fill within the prior 3 months and adherence <80% in the prior 12.³

Patients were randomized to 4 separate outreach strategies, including secure portal messaging, text message, non-secure email, or usual care (defined as no proactive outreach). Following a primary response window of 14 days, investigators assessed statin refill based on pharmacy dispensing records. Patients who refilled during this period would not receive further intervention, while those who did not were re-randomized to receive either a follow-up with the same modality, an alternative modality, or usual care.³

A total of 20,604 patients were enrolled in the study. Of these, 3154 patients had established ASCVD while 17,450 were classified as high-risk. Mean age was 54.8 years (standard deviation [SD], 9 years), and 8437 patients (40.9%) were female. Mean baseline statin adherence was 54.8% (SD, 15.7%) and mean time since prior statin fill was 205.9 days (SD, 68.5 days).²

Improving Statin Adherence Through Digital Reminders

Initial outreach increased 14-day statin refill by 14.4% compared to 12% with usual care (adjusted risk difference, 2.3%; 95% CI, 1.3-3.4; adjusted risk ratio, 1.2; 95% CI, 1.1-1.3). Among initial nonresponders, the second wave of outreach improved refill further by 13% compared to 10.4% with usual care (adjusted risk difference, 2.5%; 95% CI, 1.3-3.7; adjusted risk ratio, 1.25; 95% CI, 1.11-1.39).^1,2

Bhatt and colleagues noted that switching modalities did not improve refill over continuing with the same modality (13.2% vs 12.5%; adjusted risk ratio, 1.06; 95% CI, 0.94-1.17). Cumulative statin refill was also higher among patients receiving any digital outreach compared to those receiving usual communication over 28 days (24.9% vs. 21.2%; adjusted hazard ratio, 1.21; 95% CI< 1.13-1.3).^1,2

Ultimately, Bhatt and colleagues concluded that, while the study showed relatively modest gains in overall statin adherence and refill rates, the results reflect a simple and easy opportunity for everyday healthcare systems to improve adherence among this high-risk population. Bhatt further explains that digital reminders for statin refill are an accessible and effective method by which these systems can better serve their patients.

“I would encourage systems to use the modality that they have the most familiarity with, the one that they’ve already invested in the infrastructure for and see if the gains that we saw in our study are replicated in theirs,” Bhatt said. “I think we’ve shown that this can be done at very low cost, and you can get an answer within just a couple of months. If it’s not effective in your system, I think that is just as important as knowing if it is, because you can redeploy those efforts to other things that may produce and effect size that’s important for you.”

Editors’ Note: Bhatt reports disclosures with Amgen, AstraZeneca, Bayer, Merck, Novo Nordisk, Pfizer, and others.

References

1. Bhatt A. ADHERE-ASCVD: Adaptive Digital Outreach for Statin Adherence. Presented at the European Society of Cardiology (ESC) Congress 2026, Munich, Germany. August 28-31, 2026.

2. Bhatt AS, Liu VX, Sun B, et al. Digital Outreach to Improve Statin Refills in Patients With Low Statin Adherence: The ADHERE-ASCVD Randomized Clinical Trial. JAMA. August 29, 2026. Accessed September 9, 2026. doi:10.1001/jama.2026.16372

3. Kaiser Permanente. Adherence to Dyslipidemia Therapy: Harnessing Evidence from Randomized Evaluations in AtheroSclerotic CardioVascular Disease (ADHERE-ASCVD). Updated July 6, 2026. Accessed September 9, 2026. https://clinicaltrials.gov/study/NCT07522645