Electronic Nudge Letters Do Not Improve Guideline-Directed Medical Therapy in CKD
TUESDAY, June 17, 2025 -- Neither delivery of electronic nudge letters nor letters to general practice increase uptake of guideline-directed medical therapy (GDMT) among patients with chronic kidney disease (CKD), according to a study published online June 7 in Circulation.
Kristoffer Grundtvig Skaarup, M.D., from Copenhagen University Hospital-Herlev and Gentofte in Denmark, and colleagues examined whether electronic letter-based nudges delivered to individuals with CKD and their general practices could increase GDMT uptake in a nationwide 2-by-2 factorial implementation trial. All Danish adults with a hospital-diagnosis of CKD were randomly assigned to usual care (no letter) or to receive an electronic letter-based nudge on GDMT in CKD (11,394 and 11,223 patients, respectively). In addition, general practices of individuals with CKD were independently randomly assigned to receive no letter or an electronic information letter on GDMT (14,110 patients from 766 practices and 13,959 patients from 774 practices, respectively).
The researchers found that 65.1 and 65.9 percent of patients allocated to the patient-directed nudge and in usual care, respectively, had filled a prescription of a renin-angiotensin system inhibitor (RASi) or sodium-glucose cotransporter-2 inhibitor (SGLT2i) during follow-up. Similarly, 63.9 and 64.4 percent of patients of practices receiving the provider-directed letter and in the usual care group, respectively, filled a prescription for an RASi or SGLT2i. There was no interaction between the interventions.
"These findings represent a null result in the context of large-scale direct-to-patient implementation strategies for GDMT," the authors write. "This trial provides valuable lessons that may help inform future implementation efforts."
Several authors disclosed ties to the biopharmaceutical industry.
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