Text messaging fails to improve medication adherence in acute coronary syndrome patients
Australia: A text message-based program wherein patients received "motivational and supportive" text messages in the year following ACS did not have any effect on medical adherence but small effects on lifestyle risk factors, show results from the randomized TEXTMEDS study. The study appears in Circulation, the journal of the American Heart Association (AHA).
TEXTMEDS (Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome) was single-blind, multicenter, randomized controlled trial of patients after acute coronary syndrome (ACS). The study examined the effects of text message–delivered cardiac education and support on medication adherence after an ACS.
The study participants (n=1424; mean age, 58 years; 79% male) from 18 Australian public teaching hospitals were randomized into two groups: - the control group received usual care (secondary prevention as determined by the treating clinician); the intervention group also received multiple motivational and supportive weekly text messages on medications and healthy lifestyle with the opportunity for 2-way communication (text or telephone).
The primary end point of self-reported medication adherence was the percentage of patients who were adherent. Adherent was defined as >80% adherence to each of up to 5 indicated cardioprotective medications, at both 6 and 12 months.
Based on the study, the following findings were inferred:
- There was no significant difference in the primary end point of self-reported medication adherence between the intervention and control groups (relative risk, 0.93).
- There was no difference between intervention and control groups at 12 months in adherence to individual medications (aspirin, 96% vs 96%; β-blocker, 84% vs 84%; angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 77% vs 80%; statin, 95% vs 95%; second antiplatelet, 84% vs 84%), systolic blood pressure (130 vs 129 mm Hg), low-density lipoprotein cholesterol (2.0 vs 1.9 mmol/L), smoking, or exercising regularly (71% vs 68%).
- There were small differences in lifestyle risk factors in favor of intervention on body mass index <25 kg/m2 (21% vs 18%), eating ≥5 servings per day of vegetables (9% vs 5%), and eating ≥2 servings per day of fruit (44% vs 39%).
"The text message–based program had no effect on medical adherence but small effects on lifestyle risk factors," Clara K. Chow, Department of Cardiology, Westmead Hospital, Sydney, Australia, and colleagues concluded.
Chow CK, Klimis H, Thiagalingam A, Redfern J, Hillis GS, Brieger D, Atherton J, Bhindi R, Chew DP, Collins N, Andrew Fitzpatrick M, Juergens C, Kangaharan N, Maiorana A, McGrady M, Poulter R, Shetty P, Waites J, Hamilton Craig C, Thompson P, Stepien S, Von Huben A, Rodgers A; TEXTMEDS Investigators*. Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome: The TEXTMEDS Randomized Clinical Trial. Circulation. 2022 May 10;145(19):1443-1455. doi: 10.1161/CIRCULATIONAHA.121.056161. Epub 2022 May 9. PMID: 35533220.