短信对改善急性冠状动脉综合征后药物依从性和二级预防的作用：TEXTMEDS 随机临床试验。
Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome: The TEXTMEDS Randomized Clinical Trial.
机构信息
Westmead Applied Research Institute (C.K.C., H.K., A.T., A.V.H., A.R.), University of Sydney, Australia.
Department of Cardiology, Westmead Hospital, Sydney, Australia (C.K.C., H.K., A.T.).
出版信息
Circulation. 2022 May 10;145(19):1443-1455. doi: 10.1161/CIRCULATIONAHA.121.056161. Epub 2022 May 9.
BACKGROUND
TEXTMEDS (Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome) examined the effects of text message-delivered cardiac education and support on medication adherence after an acute coronary syndrome.
METHODS
TEXTMEDS was a single-blind, multicenter, randomized controlled trial of patients after acute coronary syndrome. The control group received usual care (secondary prevention as determined by the treating clinician); the intervention group also received multiple motivational and supportive weekly text messages on medications and healthy lifestyle with the opportunity for 2-way communication (text or telephone). The primary end point of self-reported medication adherence was the percentage of patients who were adherent, defined as >80% adherence to each of up to 5 indicated cardioprotective medications, at both 6 and 12 months.
RESULTS
A total of 1424 patients (mean age, 58 years [SD, 11]; 79% male) were randomized from 18 Australian public teaching hospitals. There was no significant difference in the primary end point of self-reported medication adherence between the intervention and control groups (relative risk, 0.93 [95% CI, 0.84-1.03]; =0.15). There was no difference between intervention and control groups at 12 months in adherence to individual medications (aspirin, 96% vs 96%; β-blocker, 84% vs 84%; angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 77% vs 80%; statin, 95% vs 95%; second antiplatelet, 84% vs 84% [all >0.05]), systolic blood pressure (130 vs 129 mm Hg; =0.26), low-density lipoprotein cholesterol (2.0 vs 1.9 mmol/L; =0.34), smoking (=0.59), or exercising regularly (71% vs 68%; =0.52). There were small differences in lifestyle risk factors in favor of intervention on body mass index <25 kg/m (21% vs 18%; =0.01), eating ≥5 servings per day of vegetables (9% vs 5%; =0.03), and eating ≥2 servings per day of fruit (44% vs 39%; =0.01).
CONCLUSIONS
A text message-based program had no effect on medical adherence but small effects on lifestyle risk factors.
REGISTRATION
URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364448; Unique identifier: ANZCTR ACTRN12613000793718.
背景
TEXTMEDS（通过短信改善急性冠状动脉综合征后药物依从性和二级预防）研究了短信传递的心脏教育和支持对急性冠状动脉综合征后药物依从性的影响。
方法
TEXTMEDS 是一项针对急性冠状动脉综合征后患者的单盲、多中心、随机对照试验。对照组接受常规护理（由治疗医生确定的二级预防）；干预组还接受了多种关于药物和健康生活方式的激励和支持性的每周短信，并有机会进行双向交流（短信或电话）。自我报告的药物依从性的主要终点是依从性大于 80%的患者比例，定义为在 6 个月和 12 个月时，对多达 5 种规定的心脏保护药物中的每种药物的依从性均大于 80%。
结果
共从 18 家澳大利亚公立教学医院随机分配了 1424 名患者（平均年龄为 58 岁[标准差为 11]；79%为男性）。干预组和对照组在自我报告的药物依从性主要终点上没有显著差异（相对风险，0.93[95%CI，0.84-1.03]；=0.15）。在 12 个月时，干预组和对照组在单独药物的依从性方面没有差异（阿司匹林，96% vs 96%；β受体阻滞剂，84% vs 84%；血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂，77% vs 80%；他汀类药物，95% vs 95%；第二种抗血小板药物，84% vs 84%[均>0.05]）、收缩压（130 与 129mmHg；=0.26）、低密度脂蛋白胆固醇（2.0 与 1.9mmol/L；=0.34）、吸烟（=0.59）或定期运动（71%与 68%；=0.52）。在有利于干预的生活方式风险因素方面存在较小差异，例如体重指数<25kg/m2（21%与 18%；=0.01）、每天食用≥5 份蔬菜（9%与 5%；=0.03）和每天食用≥2 份水果（44%与 39%；=0.01）。
结论
基于短信的方案对药物依从性没有影响，但对生活方式风险因素有较小影响。
注册
网址：https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364448；唯一标识符：ANZCTR ACTRN12613000793718。
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