Lessons from new Cochrane Review on the use of mobile phone text messaging to improve medication adherence in secondary prevention of cardiovascular disease
Worldwide, at least 100 million people have prevalent cardiovascular disease (CVD). Medications, such as antiplatelet therapy, angiotensin-converting enzyme inhibitors, beta-blockers and statins have been shown to be cost-effective, as well as safe, in reducing the risk of subsequent cardiovascular events in this population (secondary prevention medications) and are recommended in international guidelines. Unfortunately only a very small proportion of patients with known CVD are using these recommended medications. The widespread ownership of mobile phones and the possibility of automation opens the possibility to deliver at low cost and in large numbers, “behavioral change” interventions in the form of SMS that increase adherence to cardiovascular secondary prevention medications and hence prevent cardiovascular events. This strategy has proven to be successful for other chronic conditions such as HIV.
Unfortunately, the evidence to support the role of mobile phone text messaging to improve medication adherence in secondary prevention of CVD is very limited as recently exemplified by a Cochrane review1. Major limitations of the published studies are: small in sample size, short follow-up, end-points of limited clinical utility, and unclear process to support the content of SMS. To overcome these limitation, an ongoing collaboration between LSHTM UCL in UK and international partners in Colombia, India, Ghana and Singapore, with funding from MRC-UK, Colciencias and Universidad Pontificia Bolivariana in Colombia and National University of Singapore in Singapore, is now conducting the first international large-scale randomized trial to evaluate the efficacy of safety of text messages to increase adherence on cardiovascular secondary prevention (Txt2Heart Trial). This study follows state of the art methods in behavioral science to design SMS interventions, and, unlike previous studies, will be powered to detect impact on relevant clinically outcomes.
As a vanguard phase, the recruitment has started in Colombia https://clinicaltrials.gov/ct2/show/NCT03098186and planning to expand this to other low and middle income countries during 2017/18.
- Adler AJ, Martin N, Mariani J, Tajer CD, Owolabi OO, Free C, Serrano NC, Casas JP, Perel P. Mobile phone text messaging to improve medication adherence in secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2017 Apr 29;4:CD011851.