Personalized text messaging program improves healthy lifestyle measures in heart attack survivors

A text messaging program has successfully supported, informed and motivated people after a heart attack on how to prevent a second heart attack, according to new research published today in the American Heart Association’s flagship journal. Traffic. Study participants showed minor improvements in healthy lifestyle measures after 12 months, although participants had no improvement 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; manage risk factors for heart disease, including blood pressure, cholesterol and diabetes; and take medications prescribed by their cardiac care team.

TEXT Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome Study (TEXTMEDS) measured the impact of a personalized SMS assistance program on medication adherence and changes in lifestyle in people discharged from hospital after a heart attack.

Hospital admissions for people who have had a heart attack are usually short, and there may not be enough time to provide information and education to support their recovery and how to prevent another heart attack. Post-hospitalization prevention programs are helpful, but even with access to these programs, approximately two-thirds of people do not attend due to various barriers, including returning to work, inflexible program hours, distance or lack of perceived need.”

Clara K. Chow, MBBS, Ph.D., Study Lead Author, Academic Director and Professor of Medicine at Westmead Applied Research Centre, University of Sydney and Cardiologist at Westmead Hospital, Sydney, Australia

The multicentre randomized controlled study evaluated more than 1,400 adults hospitalized for a heart attack at 18 public teaching hospitals across Australia between 2013 and 2017. All people were hospitalized for a heart attack, and most were men (79%), with an average age of 58 years. After discharge from the hospital, all study participants received standard secondary heart attack prevention care such as medication, lifestyle counseling, and cardiac rehabilitation, as determined by their physician. Half of the participants (716) were randomly assigned to also receive educational, motivational and supportive text messages on their mobile phone devices.

The text messages explained blood pressure and cholesterol targets and touched on health topics such as physical activity, diet, quitting smoking and mental health after a heart attack. Medication-related text messages detailed how each of their medications worked, explained common side effects, and offered advice on the importance of taking medication regularly. A health advisor reviewed and responded to messages or questions from attendees. People in the SMS intervention group received four SMS messages per week for the first six months, then three messages per week for the next six months.

All study participants were asked at six months and 12 months about adherence to guideline-recommended medication classes for secondary heart attack prevention. The five drug classes were: angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs); beta-blockers ; statins (cholesterol); aspirin; and adenosine diphosphate (ADP) receptor antagonists.

Participants were asked how many times in the past 30 days they forgot to take a medication. They were considered adherent if, in the 6- and 12-month follow-up reports, they had taken the medication as prescribed for at least 24 of the last 30 days (80% compliance). 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 text message group and the usual care group in terms of medication adherence, as well as no difference in adherence when the researchers looked at the data by classes of individual medications.

Small lifestyle and behavioral improvements were seen among text group participants:

  • They were more likely to have a normal body mass index and more likely to report eating at least five servings of vegetables and two servings of fruit daily.

The researchers also solicited feedback from participants of the text messaging program:

  • Of the 509 patients in the text messaging group who responded to a user feedback survey, most (86%) agreed that the text messaging program was helpful.
  • Nearly two-thirds of respondents (63%) agreed that the text message program reminded them to take their medication and encouraged them to change their lifestyle.
  • 58% said their diet had become healthier as a result of the messages.
  • 48% said they exercised more regularly as a result of the text messages.

“While this study found no significant impact on medication adherence, it demonstrates that a simple, inexpensive, and personalized SMS-based program can provide systematic post-discharge education and support. to people after a heart attack with minimal support from staff,” Chow said. “The lack of impact on medication adherence suggests that external factors that we haven’t examined, such as cost, may be a factor, and barriers need to be understood and addressed in education programs. “

The researchers say the findings are likely to be generalizable to other regions, however, the study had some limitations, including that it was unblinded and the results were self-reported. Researchers did not assess medication adherence before the start of the study because many study participants would not have taken the secondary heart attack prevention medications for 30 days when they were recruited for the study. the study. Additionally, participants’ blood tests were done during routine care, rather than at a centralized location, and test dates were not strictly stipulated, meaning there may have been inconsistencies in the timing of the tests.


Journal reference:

Chow, CK, et al. (2022) Text messages to improve medication adherence and secondary prevention after acute coronary syndrome: the TEXTMEDS randomized clinical trial. Traffic.

Norma A. Roth