Motivational and supportive weekly text messages had no effect on medication adherence after acute coronary syndrome (ACS) but improvements were seen in lifestyle risk factors, according to a study published May 9 in Circulation.

Clara K. Chow, MBBS, PhD, et al., conducted a single-blind, multicenter, randomized controlled trial of patients after ACS to examine the effects of text-message delivered cardiac education and support on medication and healthy lifestyle adherence. The control group received usual care of secondary prevention as determined by the treating clinician. In contrast, the intervention group received multiple customized motivational and supportive text messages on medications and healthy lifestyle tips weekly, with an opportunity for two-way communication via text or telephone.

A total of 1,424 patients (mean age, 58 years; 21% women, 80% White) from 18 Australian public teaching hospitals were included and data were available for 1,379 patients for the primary outcome of self-reported medication adherence defined as >80% adherence to each of the five indicated cardioprotective medications at both six and 12 months.

Results showed no significant difference in the primary endpoint between the intervention and control groups (relative risk [RR], 0.93; 95% confidence interval [CI], 0.84-1.03; p=0.15), and no between-group difference was seen for individual guideline-directed medications, including aspirin, β-blocker, ACE inhibitor/ARB, statin and second antiplatelet. No difference was seen in medication adherence in exploratory analyses using pharmaceutical dispensation data. And no differences were seen in LDL-C and blood pressure control.

However, small effects were seen for lifestyle risk factors in favor of the intervention, with a greater improvement in body mass index <25 kg/m² (21% vs. 18%; p=0.01) and eating daily guideline-recommended servings of vegetables (9% vs. 5%; p=0.03), and fruit (44% vs. 39%; p=0.01).

The authors note that despite fewer lifestyle-focused texts than medication-adherence texts, the intervention participants were more likely to report adherence to healthy lifestyle practices than medication adherence. They hypothesize that external factors could be part of the reason for the lack of an effect on medication adherence. “These include social and economic factors such as medication costs, patient-doctor relationship, fixed health beliefs, belonging to an ethnic minority, depression, and reduced social support,” they write.

In an accompanying editorial comment, Abhinav Sharma, MD, PhD, et al., write, “Overall, the TEXTMEDS trial is an important step in our understanding of how mobile devices can affect health behaviors at scale.” They further state the trial raises additional questions that warrant exploration, such as who would be responsible for paying for similar interventions and whether mobile apps and digital devices will further narrow or exacerbate health care disparities.

In a perspective on ACC.org, Elizabeth A. Jackson, MD, FACC, adds, “this trial highlights the difficulty of performing behavioral trials” and that “the authors are to be applauded for a well-designed and well-conducted trial that contributes to our current knowledge of behavioral trials in this population. Targeting patients who most need additional support for pharmacologic adherence and adaptable interventions may be warranted.”

Clinical Topics: Acute Coronary Syndromes, Cardiovascular Care Team, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Social Support, Economic Factors, Healthcare Disparities, Depression, Body Mass Index, Mobile Applications, Reminder Systems, Aspirin, Pharmaceutical Preparations, Healthy Lifestyle, Risk Factors, Life Style, Medication Adherence, Angiotensin-Converting Enzyme Inhibitors, Confidence Intervals, Self Report, Acute Coronary Syndrome, Secondary Prevention, Blood Pressure, Angiotensin Receptor Antagonists, Cholesterol, LDL, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Text Messaging

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