P211 - EFFECTS OF MOBILE TEXT INTERVENTION ON TRANSITIONS OF CARE AND OUTCOMES AFTER HOSPITALIZATION WITH ACUTE CORONARY SYNDROME

Background: Despite the importance of secondary prevention in patients with acute coronary syndrome (ACS), a significant proportion fail to adhere to recommended medication regimens and miss follow-up appointments after hospitalization. This lack of adherence to both medications and follow-up care contributes to poorer long-term outcomes. Mobile health interventions have demonstrated efficacy in improving adherence to treatment in various patient populations, however, their benefits following ACS discharges have not been evaluated. Accordingly, we performed a pilot randomized placebo-controlled trial to evaluate whether mobile text messaging intervention can enhance transition of care for patients with ACS.

METHODS AND RESULTS: Effects of mobile text intervention on transitions of care and outcomes after hospitalization with ACS – The TEACH pilot randomized trial was a single-blind, multicenter, randomized controlled trial. Patients hospitalized for ACS were randomized to receive either usual cardiac care plus a 12-week motivational text message intervention vs. controlled messages. The primary outcome was outpatient family physician or cardiologist visit during 1,3, and 12 months after the discharge. Secondary outcomes included emergency department visits, all-cause rehospitalization, all-cause mortality, medication adherence, and completion of cardiovascular investigations such as echocardiography, stress testing, Holter monitoring, and electrocardiography.

A total of 228 patients were randomized. The mean age was 61.5 years; participants were predominantly male (78.5%). At 1 month there was no significant difference in the proportion of patients who visited family physician with 75.2% of patients in the intervention group and 83.5% in the control group having a family physician follow-up(p=0.123). At both 3 months and 1 year, there were also no significant differences between the groups for family physician follow-up (Figure 1A). The median time to first family physician visit was not significantly different at 1 month. However, it became modestly longer in the intervention group at both 3 months and 1 year, though the difference was not clinically meaningful (Table 1).
Cardiologist follow-up rates were similar between groups at 1 month, with 74.3% in the intervention group and 73.0% in the usual care group (p=0.825). There were no significant differences at 3 months or 1 year either (Figure 1B). The time to first cardiologist visit was similar between groups (Table 1). All-cause hospitalization, emergency department visits, diagnostic testing utilization, and medication adherence were not significantly different between the two groups (Table 1).

Conclusion: In this pilot randomized controlled trial, a mobile motivational text messaging intervention did not significantly improve outpatient follow-up, medication adherence, or clinical outcomes in ACS patients.