Abstract 18641: An m-Health Application of Daily Text Messages to Address Forgetfulness as Contributor to Non-adherence to Medications Post-myocardial Infarction

Abstract

Introduction: Forgetfulness has been consistently identified as a contributor to non-adherence to medications. In post myocardial infarction (MI) patients, up to 50% of patients may remain non-adherent to medication at one year. Text message reminders to patients’ cell phones could be a cost-effective method to reduce medication non-adherence. Hypothesis: It was hypothesized that daily text message reminders would improve adherence to medications in post-MI patients. Methods: This was a single center, randomized trial of text message system conducted in a cardiac rehabilitation facility. Patients post-MI on a once daily regimen of aspirin, a beta-blocker, an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and a statin were recruited. Participants were randomized to usual care or to receive daily text messages at the prescribed timings indicating which medication that should be taken at each time. We performed pre-specified subgroup analysis in the elderly (age ≥ 65 years) and those with less education (grade 12 or less). Results: In a two month recruitment period, ninety patients were screened and thirty-four were randomized, 36% of which were female, and with an average age of 64 years. No significant baseline differences between intervention and controls patients were identified. In the control group, adherence fell from 92% after month 1 to 70% at month 12. In the intervention group, adherence dropped from 98% after month 1 to 90% at month 12 (p<0.0001 for difference between intervention and control at month 12). In all evaluated subgroups, text message reminders consistently improved adherence to medications. Reminders appeared to particularly effective in subgroups with lower baseline adherence such as the elderly and those with less education. In interviews, forgetfulness was identified as a leading cause of their non-adherence to medications. Conclusions: In post-MI patients, this study demonstrates significant improvement in adherence to medications with an automated, daily text message reminder system over one year of follow-up. Simple and scalable systems such as this text message reminder system may improve adherence to evidence-based therapies in this high risk population by addressing forgetfulness.