Results of an Australian study published in the American Heart Association’s flagship, peer-reviewed journal Circulation show that a text messaging program designed to remind, support and motivate heart attack survivors to take their medication helped them improve their weight and eat more fruits and vegetables but interestingly, did not improve medication adherence.
According to the results of the study, participants achieved minor improvements in healthy lifestyle measures in a 12-month period.
The TEXT messages to improve MEDication adherence and Secondary prevention after acute coronary syndrome study (TEXTMEDS) evaluated the effect of the personalized text messaging support program on medication adherence and lifestyle changes among individuals discharged from hospital after a heart attack.
The text messages explained blood pressure and cholesterol targets and also included health topics such as physical activity, diet, smoking cessation and mental health after a heart attack. It also included texts about the specific medications that patients were taking, explaining how the drugs worked, common side effects and the importance of taking the medications regularly.
The heart health study is relevant to World Hypertension Day, which is observed every year on May 17. This year’s theme is ‘Measure Your Blood Pressure Accurately, Control It, Live Longer,’ which aims to raise awareness about accurate blood pressure measurement methods, especially in low- and middle-income countries.
May is also ‘May Measurement Month,’ which improves awareness by helping people check their blood pressure for free in May all around the world. High blood pressure is one of the major risk factors for heart attacks and is the number one cause of preventable deaths worldwide, according to maymeasure.org.
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One in four heart attack survivors will experience another one. This makes it important for individuals to receive education and support to help them manage risk factors such as high blood pressure, high cholesterol and diabetes. Up to 80 percent of heart attacks are preventable, which makes it critical to manage risk factors.
The multi-center randomized controlled TEXTMEDS study involved more than 1,400 adult heart attack survivors that were hospitalized for a heart attack at 18 public teaching hospitals throughout Australia between 2013 and 2017. Most of the participants were men (79 percent) and the average age was 58 years. After being discharged from the hospital, all of the study participants received standard secondary heart attack prevention care, which included medication, lifestyle counseling and cardiac rehabilitation, as prescribed by their physician. Half of the participants (716) were randomly assigned to receive the educational, motivational and supportive text messages on their mobile phone devices.
A health counselor was also part of the text messaging program and was available to review and respond to participants’ messages or questions. The people in the text intervention group received four text messages per week for the first six months followed by three messages a week over the next six months.
Participants in the study were assessed at six months and 12 months with respect to adherence to guideline-recommended classes of medications for secondary heart attack prevention. The participants received medication from five different classes, which included: angiotensin-converting-enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs); beta-blockers; statins (cholesterol-lowers); aspirin; and adenosine diphosphate (ADP) receptor antagonists.
Participants also reported specific lifestyle and health measures, including exercise habits, cholesterol levels, blood pressure readings, body mass index (BMI), smoking status and nutritional habits.
After 12 months, while there was no significant difference between the text message group and the conventional care group with respect to medication adherence (adherence was taken at 80 percent, which means patients had to have taken their prescribed medication for 24 out of the past 30 days), small improvements in lifestyle and behaviors were found among the text group participants. For example, these participants were more likely to have a normal BMI and a greater likelihood of eating at least five servings of vegetables and two servings of fruit a day.
The researchers also asked for feedback from participants in the text message program. Most participants (89 percent) agreed that the text messaging program was useful. Additionally, about two thirds agreed that the text messages reminded them to take their medications and motivated them to change their lifestyle. Other metrics included 58 percent reporting that they started eating healthier and 48 percent said they were exercising more regularly due to the text messages.
“Even though this study found no significant impact on medication adherence, it demonstrates that a simple, low-cost and customized text message-based program can deliver systematic, post-discharge education and support to people after a heart attack with minimal staff support,” said lead study author Clara K. Chow, MBBS, PhD, academic director and professor of medicine at Westmead Applied Research Centre at the University of Sydney and a cardiologist at Westmead Hospital.
“The lack of impact on medication adherence suggests external factors that we did not examine, such as cost, may be a factor, and barriers need to be understood and addressed in education programs.”
The investigators say the findings could likely be generalized to other regions, but there are several limitations of the study that need to be considered. This includes the fact that the study was not blinded and outcomes were self-reported. In addition, the researchers did not assess medication adherence before the study started because many of the participants would not have been taking the secondary heart attack prevention medications for 30 days when recruited for the study. There could also have been inconsistencies in the timing of routine blood tests, including locations and dates of testing.
Nevertheless, the study shows that personalized, supportive care post-heart attack can lead to improvements in lifestyle factors like weight and diet that can modulate key risk factors like hypertension and diabetes.