Abstract 4147824: Comparing Mobile Health Strategies to Improve Medication Adherence for Veterans with Coronary Heart Disease (Mobile4Meds): Results of a Randomized Clinical Trial

Background: Despite adherence to antiplatelet medications being critical to prevent stent thrombosis and subsequent life-threatening complications, rates of long-term non-adherence range from 21-57%. Text messaging (TM) and mobile applications (apps) are practical and inexpensive strategies to potentially promote medication adherence. Objective: The Mobile4Meds study sought to determine whether TM or a mobile app for medication adherence, compared to control, improved antiplatelet use among patients who experienced acute coronary syndrome or percutaneous coronary intervention (ACS/PCI). Methods: We recruited participants for the randomized clinical trial (RCT) from 4 national Veterans Affairs (VA) and 2 non-VA Northern California medical centers from 2018-2022. Participants were randomly assigned to: 1) customized TM on medication reminders, 2) a commercially available mobile app for self-management of medication use, or 3) control, and followed at 3, 6, and 12 months. The primary outcome was medication adherence, measured by Medication Event Monitoring System (MEMS) electronic caps. Self-reported endpoints were derived from the Adherence to Refills and Medications Scale (ARMS), and 7- and 30-day recall of all medications and antiplatelet therapy. We used linear mixed models with predictor variables of group (with control as reference), time (baseline, 3, 6 months), and group-by-time interactions to detect group differences. Results: The mean age of participants was 66.9 (SD 11), 49.5% female (N=99). Significant missingness from MEMS caps precluded conclusive analyses. No significant group differences were found with the ARMS. There were significant main effects of 7- and 30-day recall for all medications at 3 months for the app group (B=3.16, standard error [SE]=1.17, p<.01; B=-1.99, SE=0.94, p<.05, respectively) vs. the control group. Differences in 30-day recall for antiplatelet medication use were detected at 3 months; however, did not reach statistical significance (B=-2.08, SE=1.14, p<.07). Conclusions: Our study signals the efficacy of using a mobile app for short-term medication adherence based on 7- and 30-day recall. The potential of mobile technology warrants additional research including measurement methodologies as medication nonadherence remains a major public health concern for individuals with CVD requiring strict medication adherence such as antiplatelet therapy after PCI.