Text Messages to Improve Medication Adherence After ACS

Quick Takes

  • A text message-based intervention after ACS did not improve medication adherence.
  • Small improvements were observed in BMI and consumption of fruits and vegetables among the group randomized to the text message intervention.

Study Questions:

Does a text message-delivered cardiac education intervention improve medication adherence among patients after acute coronary syndrome (ACS)?


The TEXTMEDS (Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome) uses a single-blind, multicenter, randomized controlled trial study design to examine the effects of a text message–delivered cardiac education and support on medication adherence after an ACS. The study population comprised patients with a recent ACS event recruited from 13 urban and five rural centers in Australia between September 2013–February 2017. The intervention group was compared to a control group that received usual care, defined as secondary prevention, as determined by the treating clinician. The intervention group received multiple motivational and supportive weekly text messages on medications and a healthy lifestyle with the opportunity for two-way communication (text or telephone). The primary endpoint of self-reported medication adherence was the percentage of patients who were adherent, defined as >80% adherence to each of up to five indicated cardioprotective medications at both 6 and 12 months.


A total of 1,424 patients (mean age, 58 years [standard deviation, 11]; 79% male) were randomized from 18 Australian public teaching hospitals. A total of 641 and 657 participants from the intervention and control groups, respectively, completed the study. There was no significant difference in the primary endpoint of self-reported medication adherence between the intervention and control groups (relative risk, 0.93; 95% confidence interval, 0.84–1.03; p = 0.15). There was no difference between intervention and control groups at 12 months in adherence to individual medications (aspirin, 96% vs. 96%; beta-blocker, 84% vs. 84%; angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 77% vs. 80%; statin, 95% vs. 95%; second antiplatelet, 84% vs. 84% [all p > 0.05]), systolic blood pressure (130 vs. 129 mm Hg; p = 0.26), low-density lipoprotein cholesterol (2.0 vs. 1.9 mmol/L; p = 0.34), smoking (p = 0.59), or exercising regularly (71% vs. 68%; p = 0.52). There were small differences in lifestyle risk factors in favor of intervention on body mass index (BMI) <25 kg/m2 (21% vs. 18%; p = 0.01), eating ≥5 servings per day of vegetables (9% vs. 5%; p = 0.03), and eating ≥2 servings per day of fruit (44% vs. 39%; p = 0.01).


The investigators concluded that a text message–based program had no effect on medical adherence, but small effects on lifestyle risk factors.


This trial highlights the difficulty of performing behavioral trials. Patients enrolled in clinical trials may be more likely to adhere to medication, as evidenced by the control group having high rates of adherence to medical therapies. It should be noted that the intervention group was more likely to achieve a normal BMI and to meet guideline-recommended intakes of fruits and vegetables. 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, Smoking

Keywords: Acute Coronary Syndrome, Adrenergic beta-Antagonists, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Aspirin, Blood Pressure, Body Mass Index, Cholesterol, Cholesterol, LDL, Fruit, Healthy Lifestyle, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Life Style, Lipoproteins, LDL, Medication Adherence, Mobile Health Units, Myocardial Infarction, Risk Factors, Secondary Prevention, Smoking, Telemedicine, Text Messaging, Vegetables

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