A landmark analysis of the NUDGE-FLU program has demonstrated that electronic messaging highlighting cardiovascular benefits significantly improves influenza vaccination rates among heart attack survivors. The study, presented at the American Heart Association (AHA) Annual Scientific Sessions 2024, encompassed data from more than 2 million patients across three clinical trials conducted during the 2022-2023 and 2023-2024 influenza seasons.
Impact on Vaccination Rates
The analysis revealed that patients with a history of myocardial infarction showed a notably stronger response to cardiovascular-focused messaging. Among heart attack survivors, vaccination rates increased by 3.91 percentage points, compared to a 2.03 percentage point increase in patients without a cardiac history (P for interaction = .002).
Particularly striking results were observed in specific patient subgroups. Those who had not received a vaccination in the previous season showed a remarkable 13.7 percentage point increase in vaccination rates when receiving cardiovascular benefit messaging, compared to just 1.48 percentage points in other groups (P for interaction <.001). The effectiveness was also more pronounced in patients with more recent acute myocardial infarction events.
Study Design and Population
The comprehensive analysis included three distinct trials:
- NUDGE-FLU: Randomized 964,870 adults aged 65 and older (2022-2023 season)
- NUDGE-FLU-2: Included 881,373 adults aged 65 and older (2023-2024 season)
- NUDGE-FLU-CHRONIC: Studied 299,881 adults aged 18-64 with chronic conditions (2023-2024 season)
Of the total 2,146,124 participants, 59,458 (2.8%) had a documented history of acute myocardial infarction.
Clinical Significance
"Yearly influenza vaccines help prevent influenza infection and, in patients with a heart attack, are potentially cardioprotective," explained study lead author Ankeet Bhatt, MD, MBA, SCM, from Kaiser Permanente San Francisco Medical Center. Dr. Bhatt emphasized the importance of addressing the significant implementation gaps in this effective preventive therapy.
Future Implications
While the study demonstrates the effectiveness of targeted electronic messaging, researchers acknowledge that this approach alone cannot fully address vaccination gaps. "This strategy should be considered as part of a suite of strategies to improve cardiovascular prevention," noted Dr. Bhatt, suggesting that additional interventions need to be explored to fully optimize vaccination rates among high-risk patients.
The findings represent a significant step forward in understanding how behavioral science-informed communications can be leveraged to improve preventive care, particularly among vulnerable cardiac populations. The success of the NUDGE-FLU program offers a scalable model for future public health initiatives targeting improved vaccination rates.
