Weekly texts did not improve medication adherence after ACS, but may benefit lifestyle

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Weekly motivational text messages did not improve self-reported medication adherence among patients who experienced ACS vs. usual care alone, but they may have helped to improve certain lifestyle-related risk factors, researchers reported.

The results of the TEXTMEDS trial were published in Circulation.

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“Hospital admissions for people who have experienced a heart attack are generally short, and there may not be enough time to provide information and education to support their recovery and how to prevent another heart attack, ” Clara K. Chow, MBBS, PhD, academic director and professor of medicine at Westmead Applied Research Center at the University of Sydney and a cardiologist at Westmead Hospital in Sydney, said in a press release. “Post-hospitalization prevention programs are helpful, yet even with access to these programs, about two-thirds of people do not attend due to various barriers including returning to work, inflexible program hours, distance or lack of perceived need. ”

The TEXTMEDS trial

The TEXTMEDS trial was a single-blind, multicenter, randomized controlled study that assessed the value of weekly motivational and supportive text messages on medications and healthy lifestyle compared to usual care after ACS. The weekly texts gave participants an option for two-way communication via text or telephone. Usual care was defined as secondary prevention as determined by the patient’s physician.

The primary endpoint was self-reported medication adherence, defined as more than 80% adherence to each of up to five indicated cardioprotective medications, at 6 and 12 months after ACS.

The trial enrolled 1,424 patients with ACS from 18 public teaching hospitals in Australia (mean age, 58 years; 79% men).

Researchers observed no difference in self-reported medication adherence between participants who received weekly texts compared with those in the usual care arm (RR = 0.93; 95% CI, 0.84-1.03; P = .15).

Adherence to any of five individual cardioprotective medications was also not different between the intervention and usual care arms (aspirin, 96% in both groups; beta-blocker, 84% in both groups; ACE inhibitor / angiotensin receptor blocker, 77% in the intervention group vs. 80% in usual care group, statin, 95% in both groups, second antiplatelet, 84% in both groups; P for all> .05).

In addition, researchers observed no between-group differences for systolic BP (130 mm Hg vs. 129 mm Hg; P = .26), LDL level (2 mmol / L vs. 1.9 mmol / L; P = .34), smokingP = .59) or physical activity (rate of regular exercise, 71% vs. 68%; P = .52).

Potential lifestyle benefits

Although the text message intervention did not appear to affect the primary endpoint of the TEXTMEDS trial, small improvements in lifestyle risk factors were observed among participants receiving texts, such as BMI less than 25 kg / m2 21% vs. 18%; P = .01), eating five or more servings vegetables per day (9% vs. 5%; P = .03) and eating two or more servings of fruit per day (44% vs. 39%; P = .01).

“Even though this study found no significant impact on medication adherence, it demonstrates that a simple, low-cost and customized text message-based program can deliver systematic, post-discharge education and support to people after a heart attack with minimal staff support. ”Chow said in the release. “The lack of impact on medication adherence suggests external factors that we did not examine, such as cost, may be a factor, and barriers need to be understood and addressed in education programs.”


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