Electronic Nudges and Influenza Vaccination Among Patients With a History of Myocardial Infarction: Insights From 3 Nationwide Randomized Clinical Trials.

Effective strategies to improve vaccination are needed in these high-risk patients.

需要有效的策略来提高这些高风险患者的疫苗接种率。

Background

To evaluate whether electronically delivered behavioral nudges improve influenza vaccine uptake in patients with AMI across 3 nationwide implementation randomized clinical trials (RCTs).

评估电子传递的行为提示是否能改善急性心肌梗死（AMI）患者在三项全国范围内的实施随机临床试验（RCTs）中对流感疫苗的接种率。

DESIGN, SETTING, AND PARTICIPANTS: Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake (NUDGE-FLU), Nationwide Utilization of Danish Government Electronic Letter System for Confirming the Effectiveness of Behavioral Nudges in Increasing Influenza Vaccine Uptake Among Older Adults (NUDGE-FLU-2), and Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake Among Adults With Chronic Disease (NUDGE-FLU-CHRONIC) were RCTs conducted during the 2022 to 2023 and 2023 to 2024 influenza seasons in Denmark.

设计、环境和参与者：全国范围内的丹麦政府电子信件系统利用以增加流感疫苗接种率（NUDGE-FLU）、全国范围内的丹麦政府电子信件系统利用以确认行为提示在增加老年人流感疫苗接种率中的有效性（NUDGE-FLU-2）以及全国范围内的丹麦政府电子信件系统利用以增加慢性疾病成人流感疫苗接种率（NUDGE-FLU-CHRONIC）是在2022至2023年和2023至2024年流感季节在丹麦进行的三项随机临床试验（RCTs）。

Participants were randomized to either usual care or various behaviorally informed, electronically delivered, letter-based nudges.

参与者被随机分配到常规护理组或各种行为引导的、电子方式传递的、基于信件的助推干预组。

In a prespecified participant-level pooled meta-analysis, interaction of AMI status on the effects of letter-based nudges vs usual care was examined.

在预先设定的参与者级别的汇总元分析中，检查了急性心肌梗死（AMI）状态对基于信件的助推与常规护理效果的交互作用。

Pooled treatment effects were estimated using binomial regression models with identity link, adjustment for trial, and 2-way clustered SEs at the household and participant levels.

使用具有恒等链接的二项回归模型、试验调整以及在家庭和参与者层面上的双向聚类标准误来估计汇总治疗效果。

Effect modification by recency of AMI as a continuous variable was assessed using restricted cubic spline modeling in NUDGE-FLU-CHRONIC.

在NUDGE-FLU-CHRONIC中，使用限制性立方样条建模评估了作为连续变量的急性心肌梗死（AMI）近期性对效果的修饰作用。

Methods

Behaviorally informed, electronically delivered, letter-based nudges or usual care.

基于行为学的电子化信件提示或常规护理。

main_outcome_and_measures

The primary end point was influenza vaccination receipt.

主要终点是流感疫苗接种情况。

Results

Of 2 146 124 individual randomizations (mean [SD] age, 71.1 [11.6] years; 1 114 725 female [51.9%]) across all 3 trials, 59 458 (2.8%) had a history of AMI.

在所有三项试验中，共有2,146,124个个体随机化（平均[标准差]年龄为71.1[11.6]岁；1,114,725名为女性[51.9%]），其中59,458名（2.8%）有心肌梗死（AMI）病史。

Improvement in vaccine uptake was similar in patients with vs without a history of AMI who received any nudge letter compared with usual care (+1.81 vs +1.32 percentage points; P for interaction by AMI status = .09).

在收到任何鼓励信件的患者中，无论是否具有AMI病史，疫苗接种率的提高相似，与常规护理相比（+1.81 vs +1.32个百分点；AMI状态的交互作用P值= .09）。

A letter highlighting the cardiovascular benefits of vaccination (ie, cardiovascular-gain frame) resulted in larger improvements in vaccine uptake among patients with (vs without) a history of AMI (+3.91 vs +2.03 percentage points; P for interaction by AMI status = .002).

强调疫苗接种的心血管益处（即心血管获益框架）导致有（与没有）急性心肌梗死（AMI）病史的患者在疫苗接种率上有更大的改善（+3.91 vs +2.03个百分点；AMI状态的交互作用P值=.002）。

Among patients with AMI, the benefits of the cardiovascular-gain frame letter were more pronounced in those not vaccinated in the prior season (+13.7 vs +1.48 percentage points; P for interaction <.001).

在AMI患者中，心血管获益框架信件的好处在那些上个季节未接种疫苗的人中更为明显（+13.7 vs +1.48个百分点；交互作用P值<.001）。

Among younger participants with chronic disease, the cardiovascular-gain frame letter was particularly effective in patients with more recent AMI (P for interaction by continuous recency of AMI <.001).

在患有慢性疾病的年轻参与者中，心血管获益框架信件对于近期发生心肌梗死（AMI）的患者特别有效（按AMI发生时间连续变量的交互作用P值<.001）。

conclusions_and_relevance

Across 3 nationwide RCTs of Danish citizens, messaging emphasizing the cardiovascular benefits of vaccination improved influenza vaccination uptake, with greater benefits observed in patients with a history of AMI.

在三项全国性的丹麦公民随机对照试验中，强调疫苗接种的心血管益处的信息提高了流感疫苗接种率，尤其是在有心肌梗死（AMI）病史的患者中观察到更大的益处。

This low-cost, scalable implementation strategy should be considered to encourage influenza vaccination in high-risk patients.

这种低成本、可扩展的实施策略应被考虑以鼓励高风险患者接种流感疫苗。

trial_registration

ClinicalTrials.gov Identifiers: NCT05542004, NCT06030726, NCT06030739.

ClinicalTrials.gov 注册号：NCT05542004, NCT06030726, NCT06030739。