Abstract P093: AREST CAD: Adherence Effects of a Comprehensive Reminder System on Medication Adherence in Stable Cardiac Patients
Background: Non-adherence to evidence-based cardiovascular therapies is extremely common. By one year, only half of cardiac patients continue to take their medications as prescribed. Forgetfulness has been consistently identified as a contributor to medication non-adherence. With the proliferation of cell phones, text message could be a cost-effective method to remind patients to take their medications. This simple strategy has not been rigorously evaluated.
Methods: We developed a novel automated text message reminder system and assessed its stability and capacity to improve adherence to placebo in a pilot study of 20 healthy volunteers. Subsequently, we recruited 30 stable cardiac patients from a single cardiac center to test the hypothesis that such a system could be effective at addressing medication non-adherence. Eligible patients were randomized to receive text message reminders up to 4 times daily at times of their prescribed medications for month 1 and cross over to usual care (without reminders) in month 2. Alternatively, individuals were randomized to usual care (without reminders) in month 1 and crossing over to reminders in month 2 of the study. These messages simply stated, "Please take your medication now" at the time of their prescribed medications. Patients were instructed to take their medications according to their own prescribed regimen. Adherence was assessed through logbooks. Subgroup analyses of the elderly (age ≥ 65 years), patients with depression, and those with less education (grade 12 or less) were pre-specified.
Results: We randomized 30 cardiac patients with an average age of 65 years; 60% were male. Over the course of the 2 months, 100% (30 of 30) of cardiac patients improved adherence with text message reminders. There was a relative risk reduction for non-adherence of 64% with this intervention (from 1243 to 476 total missed doses, p<0.01). In all subgroups analyzed, text message reminders significantly improved medication adherence. Pre-specified subgroups exhibited lower rates of medication adherence with usual care compared to the total study population (elderly patients, patients with depression, and patients with less than grade 12 education). However, these sub-groups showed greater improvements with the text message reminder intervention (16% absolute improvement in these subgroups versus 10% in the total study population).
Conclusions: In summary, this study demonstrates the effectiveness of an automated text message reminder system to improve adherence to medications in cardiac patients over a two month period. While the impact of this intervention on clinical outcomes was not assessed, it represents a potentially simple and scalable method for improving adherence to evidence-based therapies.
Author Disclosures: A. Pandey: None.
- © 2015 by American Heart Association, Inc.