Don't Miss a Beat: Top Takeaways from NUDGE FLU at ACC 2023

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Hosts are joined by Tor Biering-Sørenson, MD, MSc, MPH, PhD, to discuss the NUDGE FLU trial and how the lessons learned can inform implementation strategies for various other types of therapies.

The growing recognition of the importance of implementation science and trials took centerstage at the American College of Cardiology 2023 Annual Scientific Session Together With the World Congress of Cardiology, with a late breaking session on day 2 of the 3-day meeting focusing on new trials in the arena of implementation science.

Among these trials was what investigators are calling the largest implementation trial ever in NUDGE FLU. With nearly a million participants, the trial examined the effects of 9 different electronic “nudges” for improving the uptake of influenza vaccines among older adults in Denmark.1

“As cardiologists, it’s very interesting that just telling people that we can also prevent other downstream issues like cardiovascular outcomes was what worked the best of all the nudge strategies—even better than the reminder, which we expected would be positive,” said Tor Biering-Sørenson, MD, MSc, MPH, PhD, professor in the Center for Translational Cardiology and Pragmatic Randomized Trials at Copenhagen University Hospital.2

Results of the trial demonstrated uptake of influenza vaccines was higher among those receiving an electronic letter highlighting potential cardiovascular benefits of vaccination (81.00% vs 80.12%; difference, 0.89 percentage points [99.55% CI, 0.29-1.48]; <.0001) and the group receiving repeated letters at randomization and at day 14 (80.85% vs 80.12%; difference, 0.73 percentage points [0.13-1.34]; P=.0006).1

With an interest in learning more about the design, results, and generalizability of this trial, Steve Greene, MD, associate professor of medicine at the Duke University School of Medicine, and Muthiah Vaduganathan, MD, MPH, codirector of the Center for Cardiometabolic Implementation Science of Brigham and Women’s Hospital who also served as an investigator on the trial, invited Biering-Sørenson to take part in a special edition episode of Don’t Miss a Beat from the floor at ACC 2023.

All episodes of Don’t Miss a Beat are available in an audio-only format on Spotify and Apple Podcasts.


  1. Biering-Sørenson T, Johansen ND, Vaduganathan M, et al. Electronic nudges to increase influenza vaccination uptake in Denmark: a nationwide, pragmatic, registry-based, randomised implementation trial. March 2023. doi:
  2. Linking flu vaccination to potential cardiovascular benefits gets more people to roll up their sleeves. American College of Cardiology. Published March 5, 2023. Accessed March 5, 2023.


Vaduganathan reports having received funding for consulting or research grants from Amgen, AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, Lexicon, and others. Here is a full list of relevant disclosures.

Greene reports having received funds for consulting or research grants from Amgen, AstraZeneca, Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, and others. Here is a full list of relevant disclosures.

Biering-Sørenson reports having received funds for consulting or research grants from Amgen.