For a TEXTMEDS study (Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome), researchers sought to determine the impact of a text message–delivered cardiac education and support on medication adherence after an ACI. TEXTMEDS was a multicenter, single-blind, randomized controlled trial of individuals suffering from the acute coronary syndrome. The control group got standard therapy (secondary prevention as decided by the treating clinician); the intervention group received many motivating and supportive weekly text messages on drugs and healthy living, with the option for two-way conversation (text or telephone). At both 6 and 12 months, the primary end objective of self-reported medication adherence was the percentage of patients who were adherent, defined as >80% adherence to each of up to five prescribed cardioprotective drugs.
A total of 1,424 patients were randomized from 18 public teaching institutions (mean age, 58 years [SD, 11]; 79% male). There was no significant difference between the intervention and control groups in the major end goal of self-reported medication adherence (relative risk, 0.93 [95% CI, 0.84–1.03]; P=0.15). At 12 months, there was no difference in adherence to individual medications (aspirin, 96% vs 96% ;β-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). Body mass index <25 kg/m2 (21% vs 18%; P=0.01), eating ≥5 servings of vegetables per day (9% vs 5%; P=0.03), and eating ≥ 2 servings of fruit per day (44% vs 39%; P=0.01) were also minor variations in lifestyle risk variables in favor of intervention. A text-messaging program had little effect on medication adherence but had minor effects on lifestyle risk factors.