Texting software has successfully supported, informed, and motivated people after a heart attack about how to prevent a second heart attack, according to new research published today in the peer-reviewed Journal of the American Heart Association. Rotation. Study participants showed little improvement in healthy lifestyle measures after 12 months, although participants did not get improvements in taking medications as prescribed.
According to the American Heart Association, up to 1 in 4 heart attack survivors will have another heart attack. To reduce their risk, people who have had a heart attack are encouraged to maintain a healthy lifestyle; managing heart disease risk factors including blood pressure, cholesterol, and diabetes; And take medications as prescribed by your heart care team.
The TEXT Messages for Improved Medication Adherence and Secondary Prevention after Acute Coronary Syndrome Study (TEXTMEDS) measured the effect of a personalized text messaging support program on medication adherence and lifestyle changes among people discharged from hospital after a heart attack.
said study lead author Clara K. Shaw, MBBS, PhD, Academic Director and Professor of Medicine at the University of Sydney’s Westmead Center for Applied Research and a cardiologist at Westmead Hospital, also in Sydney, Australia. “Posthospital prevention programs are helpful, but even with access to these, about two-thirds of people do not turn up due to various barriers including returning to work, inflexible program hours, distance, or a lack of perceived need.”
The multicenter randomized controlled study evaluated more than 1,400 adults hospitalized for heart attack at 18 public teaching hospitals across Australia between 2013 and 2017. Average age is 58 years. After discharge from hospital, all study participants received secondary standard heart attack prevention care such as medication, lifestyle counseling, and cardiac rehabilitation, as prescribed by their physician. Half of the participants (716) were randomly selected to receive educational, motivational and supportive text messages on their mobile device.
The text messages clarified blood pressure and cholesterol goals and addressed health topics including physical activity, diet, smoking cessation and mental health after a heart attack. Medication-related text messages detail how each drug works, explain common side effects and offer advice on the importance of taking medications regularly. A health advisor reviewed and responded to participants’ messages or questions. People in the text intervention group received four text messages per week for the first six months and then three text messages per week for the next six months.
All study participants were surveyed at six months and 12 months for adherence to recommended drug classes for secondary prevention of heart attacks. The five drug classes were angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs); beta blockers; statins (cholesterol reducers); aspirin; and an adenosine diphosphate (ADP) receptor antagonist.
Participants were asked how many of the past 30 days they had missed medication. They were considered adherent if they had taken medication as described in the six- and 12-month follow-up reports for at least 24 of the past 30 days (80% adherence). Participants also reported specific lifestyle and health measures, including exercise habits, cholesterol levels, blood pressure readings, body mass index, smoking status, and dietary habits.
After 12 months, there was no significant difference between the texting group and the usual care group in terms of medication adherence, and also no difference in adherence when researchers reviewed the data by individual drug classes.
Small improvements in lifestyle and behaviors were found among the participants in the script:
- They were more likely to have a normal BMI, and more likely to report eating at least five servings of vegetables and two servings of fruit each day.
The researchers also sought feedback on participants’ satisfaction with the texting program:
- Of the 509 patients in the texting group who responded to the user survey, most (86%) agreed that the texting software was helpful.
- Nearly two-thirds (63%) of respondents agreed that the texting program reminds them to take their medication and motivates them to change their lifestyle.
- 58% reported that their diet became healthier because of the messages.
- 48% reported that they were exercising more regularly as a result of texting.
“Although this study did not find any significant effect on medication adherence, it shows that a simple, low-cost, customized program based on text messages can provide systematic post-hospital education and support for people after a heart attack with minimal staff support Zhao said. “The lack of influence on medication adherence suggests that external factors that we did not examine – such as cost – may be a factor, and barriers should be understood and addressed in education programmes.”
The researchers say the results are likely to be generalizable to other areas, however, the study has some limitations, including that it was not blinded and the results were self-reported. The researchers did not assess medication adherence before the study began because many of the study participants had not taken secondary heart attack prevention medications for 30 days when they were recruited for the study. In addition, participants’ blood tests were taken during routine care, rather than taken in a central location, and test dates were not precisely scheduled, which means there may be inconsistencies in the timing of testing.
Review: mHealth Texting Boosts Medication Adherence
Clara K. Chow et al, Texting to improve medication adherence and secondary prevention after acute coronary syndrome: the TEXTMEDS randomized clinical trial, Rotation (2022). DOI: 10.1161 / CIRCULATIONAHA.121.056161
Submitted by the American Heart Association
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