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The study led by Kaiser Permanente researchers included more than 25,000 Danish citizens.
A new Kaiser Permanente study finds that people who have had a heart attack are more likely to receive an email explaining the heart health benefits of a vaccine than a letter promoting other reasons for getting vaccinated. It was found that people responded better to the flu shot reminder.
The findings were presented at the annual scientific session of the American College of Cardiology and simultaneously published in the European Heart Journal.
The study involved 25,064 Danish people who had had a heart attack within the past 10 years. They were all participants in a large nationwide randomized trial of about 965,000 Danish citizens called NUDGE-FLU. The NUDGE-FLU trial compared the effectiveness of nine different letters encouraging influenza vaccination during the 2022-2023 influenza season in Denmark. All nine letters made arguments based on behavioral science about the importance of getting the flu shot.

The NUDGE-FLU study found that letters emphasizing the cardiovascular benefits of the influenza vaccine were most effective in increasing vaccination rates compared to usual care. A new study found that among people who had had a heart attack, letters explaining cardiovascular benefits increased the absolute number of vaccinations by more than 2.5% compared to those who received a standard letter. There was found.
“Overall, the Danish public responded best to a letter explaining the cardiovascular benefits of the influenza vaccine,” said lead author Ankeet Bhatt, M.D., a researcher in the Kaiser Permanente Research Division and a cardiologist at Permanente Medical. , MBA, ScM said. group. “This is particularly important for patients with a history of heart attack, for whom vaccination has been shown to improve cardiovascular disease outcomes. Currently, the latest guidelines from the European Society of Cardiology recommend that patients who have had a heart attack in the past Influenza vaccination is strongly recommended for everyone who has had a history of influenza, necessitating implementation strategies to improve vaccination for this high-risk group. This analysis shows that the message We hope to increase our knowledge of how patients can be more motivated.”
At the time of receiving the email promoting the influenza vaccine, 1,368 (5%) of patients had experienced a heart attack within the past 6 months, and 1,398 (6%) had experienced a heart attack within 6 to 12 months. , 2,860 people (11%) had experienced a heart attack within 12 to 12 months. 19,438 (78%) within 24 months, and 19,438 (78%) within 24 months.
The study found that in 2022-2023, 21,022 (83.9%) people who had a heart attack received the vaccine, compared to 772,078 (82.2%) people who did not have a heart attack. It turned out that it was. The improvement in vaccination rates among patients who received a letter emphasizing the cardiovascular benefits of vaccination was consistent regardless of how long the patient had had a heart attack or the type of heart attack.
Previous research has shown that people with influenza have an increased risk of having a heart attack. Studies also show that the vaccine reduces the risk of more severe heart disease in people who have recently had a heart attack.
NUDGE-FLU is possible because every Danish citizen has an email address that the government uses to contact them about matters of national interest. All participants in the study were eligible to receive a free influenza vaccine. The research team is currently running two new trials in Denmark to test vaccination messaging strategies, one of which will specifically focus on people with chronic diseases.
“Our study highlights the effectiveness of using a behavioral science-based, low-cost, low-touch approach – the email letter – to improve influenza vaccination rates.” Mr. Butt said. “But we also believe that this study’s findings go beyond the flu vaccine. We encourage Kaiser Permanente Northern California members to get vaccinated for COVID-19, pneumonia, and other evidence-based treatments.” We would like to study similar strategies to
The NUDGE-FLU study was supported by Sanofi.
Co-authors include Tor Biering-Sørensen, MD, MS, MPH, PhD, Niklas Dyrby Johansen, MD, Daniel Modin, MD, and Pradeesh Sivapalan, MD, PhD, of Copenhagen University Hospital. Brian L. Clagett, MD, Scott D. Solomon, MD, Muttiah Vaduganathan, MD, MPH; Brigham and Women’s Hospital. Dr. Erica L. Duger, Dr. Sandrine I. Samson, and Dr. Matthew M. Loiacono of Sanofi; Lars Kober, MD, Jens Ulrik Starr Jensen, MD, PhD, University of Copenhagen; Dr. Cyril Jean-Marie Martel of the Statens Serum Institute for Epidemiology and Infectious Disease Control in Copenhagen.
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About Kaiser Permanente Research Department
Kaiser Permanente’s Research Division conducts, publishes, and disseminates epidemiology and health services research to improve the health and health care of Kaiser Permanente members and society as a whole. We aim to understand the determinants of disease and health and improve the quality and cost-effectiveness of healthcare. Currently, his more than 600 staff at DOR are working on more than 450 epidemiology and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow @KPDOR.
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