A Sentiment and Content Analysis of 491 Tweets from 2016-2019 to Better Understand Patient and Caregiver Perspectives of P2Y12 Inhibitor Usage to Design Tailored Interventions to Support Adherence to Improve Cardiovascular Outcomes

Background: One in every six patients post percutanous coronary intervention (PCI) are non-adherent to P2Y12 inhibitors which has been shown to negatively impact cardiovascular outcomes leading to stent thrombosis, death, and hospital readmissions. Unfortunately, multiple prior interventions to address adherence have made only marginal improvements in adherence. Qualitative research offers an opportunity to better understand the critical drivers of nonadherence to P2Y12 inhibitors among post PCI patients which can help design future interventions to better address the underlying problem. Today, the widespread use of social media platforms and application of sentiment and content analysis provide an opportunity to better understand these factors in a real-world population.

Methods: We searched public Twitter posts from Jan 01, 2016 to Dec 31, 2019 using the search terms of both generic and brand names of P2Y12 inhibitors including “Clopidogrel or Plavix,” “Ticagrelor or Brilinta,” and “Prasugrel or Effient.” Aspirin was excluded from analysis. Posts were excluded if they were non-English, duplicates, medical media, or included usernames with clinical titles. Each post was then manually reviewed for screening and analysis. Eligible posts had to include text from the perspective of an individual personally affected by issues related to taking DAPT. Using an integrated approach with both conventional content and directed content analysis using the Theoretical Domains Framework, eligible posts were categorized into themes of DAPT concordance and further classified by sentiment and emotion.

Results: We identified 50,525 Twitter posts about DAPT of which 491 met inclusion criteria. As expected, nearly two thirds of the tweets had negative sentiments with the following top 3 emotional classifications of anger, sadness, and fear. Posts with neutral sentiment were initiated to inquire or share patient experiences with taking DAPT. The following DAPT concordance framework was developed (www.daptdecisionaid.org; password kairos) to link the constructs of adherence to useful intervention designs.