Photo for ISLAND


Official Title

Interventions to Support Long-term adherence aNd Decrease cardiovascular events post Myocardial Infarction




For patients who have had a myocardial infarction (MI) and coronary artery disease, guidelines recommend cardiac rehabilitation services and the long‐term use of cardiac medications to reduce the risk of recurrent cardiovascular events. These treatments are proven to improve quality of life and reduce the risk of repeat heart attacks or death amongst persons who have already had one heart attack. However, research shows that many people who have had a heart attack do not stick with these treatments and therefore cannot benefit from them. The ISLAND study is a quality improvement research program that seeks to understand the impact of low-cost interventions that could be readily implemented at scale by entire health systems or organizations wishing to improve adherence to proven treatments. Specifically, the trial will test whether providing Ontario‐based patients (and their health professionals) with repeated educational reminders delivered via post and phone will help improve the medication adherence and attendance at cardiac rehabilitation.

Study Design

Pragmatic, randomized controlled trial with blinded outcome assessment.

Primary Endpoint

This project has the potential to lead to improvements in care for patients at high cardiovascular risk as well as provide generalizable insights regarding how to optimize interventions to improve medication adherence as well as attendance at cardiac rehabilitation services. The trial team are partnering in this project with health system decision makers who have an interest in using the results to create standard operating procedures that could benefit patients across the province. Furthermore, it also has the potential to inform how other health databases could be used to improve health system performance.

Number of Patients


Number of Sites


Number of Countries


Study Period


Principal Investigator

JD Schwalm, Noah Ivers

Program Manager

Tara McCready

Research Coordinator

Jennifer Cunningham, Shelley Smarz, Beth Bosiak


Women’s Health College, University of Toronto, Ottawa Hospital Research Institute, University of Ottawa, Ontario Ministry of Health and Long-Term Care (MOHLTC)

Key Publications

  • Study design paper: Ivers N, Schwalm JD, Witteman HO, Presseau J, Taljaard M, McCready T, Bosiak B, Cunningham J, Smarz S, Desveaux L, Tu JV, Atzema C, Oakes G, Isaranuwatchai W, Grace SL, Bhatia RS, Natarajan M, Grimshaw JM. Interventions Supporting Long-term Adherence aNd Decreasing cardiovascular events (ISLAND): Pragmatic randomized trial protocol. Am Heart J. 2017 Aug;190:64-75. doi: 10.1016/j.ahj.2017.05.007. Epub 2017 May 21.
  • Intervention design paper: Witteman HO, Presseau J, Nicholas Angl E, Jokhio I, Schwalm JD, Grimshaw JM, Bosiak B, Natarajan MK, Ivers NM. Negotiating Tensions Between Theory and Design in the Development of Mailings for People Recovering From Acute Coronary Syndrome. JMIR Hum Factors. 2017 Mar 1;4(1):e6. doi: 10.2196/humanfactors.6502.