Email Nudges Boost Flu Vaccination Among High-Risk Heart Patients
Research from the NUDGE-FLU trials reveals that targeted email reminders focusing on cardiovascular benefits significantly enhance flu vaccination rates in individuals at high risk, particularly those with a history of acute myocardial infarction (MI). This analysis emphasizes the importance of tailored messaging in public health campaigns, especially for those hesitant about vaccines.
High Stakes for Heart Patients During Flu Season
CHICAGO, IL—In a compelling study presented at the American Heart Association 2024 Scientific Sessions, Dr. Ankeet S. Bhatt from Kaiser Permanente San Francisco Medical Center shed light on the correlations between influenza and cardiovascular health challenges. He noted that the flu not only leads to widespread morbidity and mortality but also escalates the risk of serious cardiovascular events such as acute myocardial infarction.
The pooled analysis of the NUDGE-FLU program included data from three distinct trials conducted in Denmark, leveraging the country’s government email system to send reminders about the importance of flu shots for heart health. These proactive communications proved especially effective for those who had not received their flu vaccine in the previous year, as well as younger patients recovering from more recent MIs.
The Impact of Targeted Messaging
Orly Vardeny, PharmD from Minneapolis VA Health Care System, emphasized the heavy toll influenza takes on the U.S. healthcare system. According to the Centers for Disease Control and Prevention, the 2023-2024 flu season resulted in approximately 34 million symptomatic cases, over 15 million medical visits, around 380,000 hospitalizations, and 17,000 flu-related deaths, with nearly half of those hospitalized suffering from cardiovascular diseases.
"Every year, people must decide whether to get their flu vaccination," Vardeny stated, highlighting the varied intentions behind these choices. Some consistently opt in, others decline, while a significant portion remains undecided. This indecisive group is where targeted messaging can have the most significant impact.
The NUDGE-FLU trial results clearly indicate that addressing the concerns of those unsure about vaccination, particularly high-risk patients, can effectively enhance flu shot uptake.
Generalizability of Findings
While the Danish healthcare system offers unique features—such as free flu shots and the ability to track vaccination rates through a national registry—Dr. Bhatt believes certain strategies can be applied in the United States. “Despite differences in systems, the underlying principles of effective communication resonate universally," he added. "Large healthcare systems in the U.S. also possess online portals and electronic health records that can facilitate similar vaccination reminder efforts."
However, the ongoing debates around vaccination in the U.S. necessitate additional validation studies to analyze how well these results can be replicated here—particularly in a country where vaccine acceptance is increasingly contentious.
Analysis of NUDGE-FLU Data
The comprehensive analysis, published in JAMA Cardiology, encompassed data from three trials: NUDGE-FLU (for patients aged 65 and older during the 2022-2023 season), NUDGE-FLU-2 (involving similar demographics for the 2023-2024 season), and NUDGE-FLU-CHRONIC (which focused on individuals aged 18-64 with chronic conditions). In total, over 2.1 million participants were randomized to receive either nudges or standard care, with 59,458 identified as acute MI survivors.
- Flu vaccination rates at baseline were comparable for patients with and without a history of acute MI, showing that 84% versus 82% had received their flu shot in NUDGE-FLU and 78% versus 76% in NUDGE-FLU-2.
- The younger NUDGE-FLU-CHRONIC group revealed stark gaps in vaccination, with only 40% of those with an MI history and 36% without getting vaccinated.
Results showed that the nudge intervention improved vaccination uptake by an additional 1.81 percentage points for any nudge letter, regardless of prior MI status. However, letters that specifically highlighted cardiovascular benefits were particularly advantageous—accruing an increase of 3.91 percentage points for MI survivors compared to just 2.03 percentage points for those without a history.
Notably, the CV-focused messaging had a pronounced effect on patients who had not been vaccinated in the prior season, reflecting a significant engagement opportunity.
Dr. Bhatt concluded, “If validated, a cardiovascular-focused messaging strategy signifies a simple, scalable, and effective approach to enhance vaccination rates among high-risk patients.”
Navigating Vaccine Hesitancy in the U.S.
In an editorial accompanying the study, Drs. Mohammad Madjid and Payam Safavi-Naeini highlighted the necessity of caution when translating these Danish findings to the U.S. landscape. They noted that a mere one-third of adults aged 18 to 44 and about 50% of those aged 45 to 64 received flu shots last season.
The editorial underscores that beyond access and economic considerations, public hesitancy—exacerbated by misinformation surrounding vaccinations—complicates the landscape for flu shot acceptance. They advocate for a coordinated response from healthcare stakeholders to address these barriers and improve vaccination outcomes across the population.
As the public continues to navigate the complexities of health decisions, particularly in the realm of vaccinations, the findings from the NUDGE-FLU trials provide a blueprint for effective engagement and outreach strategies to improve public health outcomes.
What are your thoughts on the use of targeted messaging for vaccination campaigns? Join the conversation by sharing your insights in the comments below!
How can the insights gained from the NUDGE-FLU trials be utilized to address vaccine hesitancy in the United States, particularly among vulnerable populations?
Welcome to our latest interview on the exciting findings from the NUDGE-FLU trials. Today, we have with us Dr. Ankeet S. Bhatt from Kaiser Permanente San Francisco Medical Center and Orly Vardeny, PharmD from Minneapolis VA Health Care System to discuss the impact of targeted messaging on flu vaccination rates among high-risk heart patients.
Editors: Thank you both for joining us today. To begin with, Dr. Bhatt, could you please share your experience working on the NUDGE-FLU trials and highlight the importance of tailored messaging in public health campaigns?
Dr. Ankeet S. Bhatt: Absolutely! The NUDGE-FLU trials have been an incredible learning opportunity for us, and the results are quite remarkable. It’s clear that tailored messaging can have a significant impact on vaccination rates among high-risk patients. By focusing on cardiovascular benefits, we were able to show that people who were previously hesitant about getting the flu shot were more likely to do so. This has major implications for public health campaigns, especially those aimed at groups that may have concerns about vaccine safety or efficacy.
Editors: Great insights, Dr. Bhatt. Orly, as a pharmacist, how does the issue of vaccine hesitancy impact your work? And do you think the findings from the NUDGE-FLU trials could be applied in the United States?
Orly Vardeny, PharmD: Vaccine hesitancy is a persistent issue in healthcare, and I think it’s important to remember that there are varying reasons why someone might choose not to get vaccinated. Understanding these reasons can help us develop more effective communication strategies to address their concerns. The findings from the NUDGE-FLU trials seem promising, especially given the ongoing debates around vaccination in the U.S. However, we do have unique challenges here, such as widespread misinformation and the high cost of healthcare. Replicating these results would require validating them within our own healthcare system and tailoring the messaging to fit our specific population.
Editors: That’s a great point
