The impact of text messaging on medication adherence and exercise among post-myocardial infarction patients: a randomized control pilot trial

ABSTRACT Background: Adherence to evidence-based therapies such as medications and exercise remains poor among patients after myocardial infarction (MI). Text message reminders have been shown to improve rates of regular medication taking and exercise but existing studies have been of short duration. Objective: Two single-center randomized controlled pilot trials were conducted to evaluate the impact of text message reminders over twelve months on adherence to cardiac medications and exercise among patients receiving cardiac rehabilitation after hospitalization for MI. Methods: In the medication adherence trial, 34 patients were randomized to receive usual care alone or usual care plus daily text message reminders delivered at the time of day at which medications were to be taken. In the exercise adherence trial, 50 patients were randomized to receive usual care alone or usual care plus four daily text messages reminding them to exercise as directed. Results: Text messages led to a mean 14.2 percentage point improvement in self-reported medication adherence over usual care (95% CI 7 – 21). In the exercise trial, text messages resulted in 4.2 (95% CI 1.9 – 6.4) more days and 4.0 hours (95% CI 2.4 – 5.6) of exercise per month over usual care, and a non-significant increase of 1.2 metabolic equivalents or METS (P=0.06) in exercise capacity, as assessed by a BRUCE protocol at 12 months. Conclusions: Text message reminders significantly increased adherence to medication and exercise among post-MI patients receiving care in a structured cardiac rehabilitation program. This technology represents a simple and scalable method to ensure consistent use of evidence-based cardiovascular therapies. ClinicalTrial: NCT02783287 at clinicaltrials.gov