Table 2.

Randomized controlled trials including patients with ischaemic heart disease that used mHealth to improve medication adherence

Study	Design	Population	Study intervention	Results	Limitations
Quilici et al. (2013)20	RCT 1 month	n = 546 Patients with ACS status post-PCI shown to be aspirin-responsive	Daily SMS reminders for aspirin adherence vs. control; 1 month after hospital discharge admitted to Antiplatelet Monitoring Unit to compare adherence and platelet function	SMS reminders improved aspirin adherence as reported by patients (OR [95% CI]: 0.37 [0.15–0.90]; P = 0.02) and as shown by platelet testing (OR [95% CI]: 0.43 [0.22–0.86]; P = 0.01)	– No long-term follow-up for sustained response – Cost of platelet testing for feasibility in general population
Vollmer et al. (2014)21	RCT 1 year	n = 21 752 Patients with CVD ± type 2 diabetes and suboptimal medication adherence	Arm 1: Interactive voice recognition phone calls (IVR) Arm 2: IVR-enhanced (IVR+) phone calls, letters, EMR-feedback, mailed materials Control: Usual care	Both phone interventions significantly increased adherence to statins (IVR+ equal to IVR) and ACEIs/ARBs (IVR+ more than IVR) compared with usual care (1.6–3.7%).	– Most participants did not respond to automated voice recognition calls – No long-term follow-up
Wald et al. (2014)22	RCT 6 months	n = 301 Patients prescribed blood pressure and/or lipid lowering meds	Automated daily TM for 2 weeks, alternate days for 2 weeks, then weekly with the goal to assess patients' adherence vs. control (no text)	Lower non-adherence rates among TM group 14/150 (9%) vs. control 38/151 (25%) (95% CI: 7–24), P < 0.001. Non-adherence defined as taking <80% of prescribed regimen	– Short duration – Baseline educational status and acceptance of technology was not assessed
Park et al. (2014)23	RCT 30 days	n = 90 Patients with ACS status post-PCI at time of discharge	Arm 1: TM for medication and reminders Arm 2: Educational TM Control: No TM Adherence monitored MEMS for statin and antiplatelet	TM patients had higher percentage of correct doses taken (P = 0.02), taken on schedule (P = 0.01), percentage number of doses (P = 0.01)	– Self-reported medication adherence – Hawthorne effect of using MEMS – Lacks long-term follow-up
Fang and Li (2015)24	RCT 6 months	n = 280 Patients with CAD confirmed by CT or angiography	Arm 1: SMS Arm 2: SMS + Micro Lettera Control: Phone only	Intervention groups had higher cumulative adherence; SMS + Micro Letter (OR [95% CI]: 0.069 [0.032–0.151], P=<0.001), SMS only (OR [95% CI]: 0.339 [0.183–0.629])	– Single site data – Cellular data plan required, limits rural participants
Khonsari et al. (2015)25	RCT 8 weeks	n = 62 Patients post-hospital discharge following ACS	Automated SMS-based reminders on medication adherence vs. control (no text)	Medication adherence and heart functional status were higher in SMS group (P < 0.001); control group had 4.09 times greater risk of low adherence (95% CI: 1.82–9.18)	– Short follow-up – Single centre – Small sample size – Lacks evidence if readmission or death secondary to medication non-adherence

AA-Ag, arachidonic acid-induced platelet aggregation; ACEI/ARB, angiotensin-converting enzyme/angiotensin receptor blocker; ACS, acute coronary syndrome; CAD, coronary artery disease; CI, confidence interval; DBP: diastolic blood pressure; EMR, electronic medical record; IVR, interactive voice response calls; LDL-C: low-density lipoprotein cholesterol; MEMS, Medication Event Monitoring System; NNT, number needed to treat; OR, odds ratio; PCI, percutaneous coronary intervention; SBP, systolic blood pressure; SMS, short messaging service; TM, text messaging.

^aMicro Letter platforms provide users in China with access to news and other information via open-access Kik Messenger-like programs.