Electronic Nudges and Influenza Vaccination Among Patients With a History of Myocardial Infarction: Insights From 3 Nationwide Randomized Clinical Trials
Authors' conclusion
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.
Study context
- Population
- Danish citizens randomised in 3 trials, 2022–2023 and 2023–2024 influenza seasons; patients with vs without a history of acute myocardial infarction (AMI)59,458 (2.8%) with AMI history
- Participants
- 2,146,124 participants
- Comparison
- Electronic letter-based nudges vs usual care, by history of AMI
- Outcome
- Influenza vaccination receipt
Methodological detailsNUDGE-FLU, NUDGE-FLU-2, NUDGE-FLU-CHRONIC, subgroup analysis by AMI status
- NUDGE-FLU, NUDGE-FLU-2, NUDGE-FLU-CHRONIC
- Subgroup analysis by AMI status
Pooled result
As reported in the abstract
Vaccine uptake, any nudge letter vs usual care, by AMI history
Absolute difference
+1.81 percentage points
history of AMI
Absolute difference
+1.32 percentage points
no history of AMI
Further pooled results
| Outcome | Absolute difference (percentage points) |
|---|---|
| Vaccine uptake, cardiovascular-gain frame letter vs usual care, by AMI historyCardiovascular-gain frame letter vs Usual care · history of AMI | +3.91 |
| Vaccine uptake, cardiovascular-gain frame letter vs usual care, by AMI historyCardiovascular-gain frame letter vs Usual care · no history of AMI | +2.03 |
| Vaccine uptake, cardiovascular-gain frame letter in AMI patients, by prior-season vaccinationCardiovascular-gain frame letter vs Usual care · not vaccinated in prior season | +13.7 |
| Vaccine uptake, cardiovascular-gain frame letter in AMI patients, by prior-season vaccinationCardiovascular-gain frame letter vs Usual care · vaccinated in prior season | +1.48 |
- Vaccine uptake, cardiovascular-gain frame letter vs usual care, by AMI history: interaction P=.002
- Vaccine uptake, cardiovascular-gain frame letter in AMI patients, by prior-season vaccination: interaction P<.001
Cardiovascular-gain frame letter effect by recency of AMI (NUDGE-FLU-CHRONIC, younger participants with chronic disease)
- Particularly effective with more recent AMI
- P for interaction < 0.001
Original publication
Electronic Nudges and Influenza Vaccination Among Patients With a History of Myocardial Infarction: Insights From 3 Nationwide Randomized Clinical Trials. JAMA Cardiol. Published 1 January 2025. doi:10.
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