@Article{info:doi/10.2196/65010,
author="Yoon, Minjae
and Lee, Ji Hyun
and Kim, In-Cheol
and Lee, Ju-Hee
and Kim, Mi-Na
and Kim, Hack-Lyoung
and Lee, Sunki
and Kim, In Jai
and Choi, Seonghoon
and Park, Sung-Ji
and Hur, Taeho
and Hussain, Musarrat
and Lee, Sungyoung
and Choi, Dong-Ju",
title="Smartphone App for Improving Self-Awareness of Adherence to Edoxaban Treatment in Patients With Atrial Fibrillation (ADHERE-App Trial): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="21",
volume="26",
pages="e65010",
keywords="mobile apps; digital health; atrial fibrillation; anticoagulants; medication adherence; mobile phone",
abstract="Background: Adherence to oral anticoagulant therapy is essential to prevent ischemic stroke in patients with atrial fibrillation (AF). Objective: This study aimed to evaluate whether smartphone app--based interventions improve medication adherence in patients with AF. Methods: This open-label, multicenter randomized controlled trial (ADHERE-App [Self-Awareness of Drug Adherence to Edoxaban Using an Automatic App Feedback System] study) enrolled patients with AF treated with edoxaban for stroke prevention. They were randomly assigned to app-conditioned feedback (intervention; n=248) and conventional treatment (control; n=250) groups. The intervention group received daily alerts via a smartphone app to take edoxaban and measure blood pressure and heart rate at specific times. The control group received only standard, guideline-recommended care. The primary end point was edoxaban adherence, measured by pill count at 3 or 6 months. Medication adherence and the proportion of adequate medication adherence, which was defined as ≥95{\%} of continuous medication adherence, were evaluated. Results: Medication adherence at 3 or 6 months was not significantly different between the intervention and control groups (median 98{\%}, IQR 95{\%}-100{\%} vs median 98{\%}, IQR 91{\%}-100{\%} at 3 months, P=.06; median 98{\%}, IQR 94.5{\%}-100{\%} vs median 97.5{\%}, IQR 92.8{\%}-100{\%} at 6 months, P=.15). However, the proportion of adequate medication adherence (≥95{\%}) was significantly higher in the intervention group at both time points (76.8{\%} vs 64.7{\%} at 3 months, P=.01; 73.9{\%} vs 61{\%} at 6 months, P=.007). Among patients aged >65 years, the intervention group showed a higher medication adherence value and a higher proportion of adequate medication adherence (≥95{\%}) at 6 months. Conclusions: There was no difference in edoxaban adherence between the groups. However, the proportion of adequate medication adherence was higher in the intervention group, and the benefit of the smartphone app--based intervention on medication adherence was more pronounced among older patients than among younger patients. Given the low adherence to oral anticoagulants, especially among older adults, using a smartphone app may potentially improve medication adherence. Trial Registration: International Clinical Trials Registry Platform KCT0004754; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=28496{\&}search{\_}page=L International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-048777 ",
issn="1438-8871",
doi="10.2196/65010",
url="https://www.jmir.org/2024/1/e65010",
url="https://doi.org/10.2196/65010",
url="http://www.ncbi.nlm.nih.gov/pubmed/39570659"
}