Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia.
Department of Statistics, The University of Auckland, Auckland, New Zealand.
JMIR Mhealth Uhealth. 2021 Jun 9;9(6):e24952. doi: 10.2196/24952.
Mobile health technologies have the potential to improve the reach and delivery of interventions for promoting long-term secondary prevention of coronary heart disease.
This study aims to determine the effectiveness of an SMS text messaging intervention (Text4HeartII) for improving adherence to medication and lifestyle changes over and above usual care in people with coronary heart disease at 24 and 52 weeks.
A two-arm, parallel, randomized controlled trial was conducted in New Zealand. Participants with a recent acute coronary syndrome were randomized to receive usual cardiac services alone (control, n=153) or a 24-week SMS text message program for supporting self-management plus usual cardiac services (n=153). The primary outcome was adherence to medication at 24 weeks, defined as a medication possession ratio of 80% or more for aspirin, statin, and antihypertensive therapy. Secondary outcomes included medication possession ratio at 52 weeks, self-reported medication adherence, adherence to healthy lifestyle behaviors, and health-related quality of life at 24 and 52 weeks.
Participants were predominantly male (113/306, 80.3%) and European New Zealanders (210/306, 68.6%), with a mean age of 61 years (SD 11 years). Groups were comparable at baseline. National hospitalization and pharmacy dispensing records were available for all participants; 92% (282/306, 92.1%) of participants completed a 24-week questionnaire and 95.1% (291/306) of participants completed a 52-week questionnaire. Adherence with 3 medication classes were lower in the intervention group than in the control group (87/153, 56.8% vs 105/153, 68.6%, odds ratio 0.60, 95% CI 0.38-0.96; P=.03) and 52 weeks (104/153, 67.9% vs 83/153, 54.2%; odds ratio 0.56, 95% CI 0.35-0.89; P=.01). Self-reported medication adherence scores showed the same trend at 52 weeks (mean difference 0.3; 95% CI 0.01-0.59; P=.04). Moreover, self-reported adherence to health-related behaviors was similar between groups.
Text4HeartII did not improve dispensed medication or adherence to a favorable lifestyle over and above usual care. This finding contrasts with previous studies and highlights that the benefits of text interventions may depend on the context in which they are used.
Australian New Zealand Clinical Trials Registry ACTRN12616000422426; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370398.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-018-2468-z.
移动健康技术有可能改善促进冠心病长期二级预防的干预措施的覆盖面和实施效果。
本研究旨在确定短信文本消息干预（Text4HeartII）在 24 周和 52 周时对改善药物治疗依从性和生活方式改变的有效性，与常规护理相比。
这是一项在新西兰进行的双臂、平行、随机对照试验。最近发生急性冠状动脉综合征的参与者被随机分配接受单独的常规心脏服务（对照组，n=153）或接受 24 周的支持自我管理的短信文本消息计划加常规心脏服务（n=153）。主要结局是 24 周时的药物治疗依从性，定义为阿司匹林、他汀类药物和抗高血压治疗的药物使用比例达到 80%或更高。次要结局包括 52 周时的药物使用比例、自我报告的药物依从性、健康生活方式行为的依从性以及 24 周和 52 周时的健康相关生活质量。
参与者主要为男性（113/306，80.3%）和欧洲新西兰人（210/306，68.6%），平均年龄为 61 岁（SD 11 岁）。两组在基线时具有可比性。所有参与者的国家住院和药房配药记录均可获得；92%（282/306，92.1%）的参与者完成了 24 周的问卷调查，95.1%（291/306）的参与者完成了 52 周的问卷调查。干预组的 3 种药物治疗的依从性均低于对照组（87/153，56.8%比 105/153，68.6%，比值比 0.60，95%CI 0.38-0.96；P=.03）和 52 周（104/153，67.9%比 83/153，54.2%；比值比 0.56，95%CI 0.35-0.89；P=.01）。52 周时自我报告的药物依从性评分也显示出相同的趋势（平均差异 0.3；95%CI 0.01-0.59；P=.04）。此外，两组的自我报告健康相关行为依从性相似。
Text4HeartII 并没有在常规护理的基础上改善药物治疗或有利于健康的生活方式。这一发现与以往的研究结果形成对比，强调了短信干预的益处可能取决于其使用的背景。
澳大利亚新西兰临床试验注册中心 ACTRN12616000422426；http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370398。
国际注册报告标识符（IRRID）：RR2-10.1186/s13063-018-2468-z。
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