Effects of Mobile Text Intervention on Transitions of Care and Outcomes after Hospitalization with Acute Coronary Syndrome - The TEACH (TExting After acute coronary syndrome discHarge) Pilot Randomized trial (Preprint)

BACKGROUND Suboptimal transition of care after acute coronary syndrome (ACS) contributes to the persistently high risk of adverse cardiovascular events following hospitalization. Although mobile health interventions are growing rapidly, whether a mobile text messaging intervention can improve patient follow-up, other care processes, or outcomes after ACS has not been evaluated. OBJECTIVE To evaluate whether a hospital-initiated mobile health intervention for patients with acute coronary syndrome improves post discharge care processes and clinical outcomes. METHODS We conducted the TExting after Acute coronary syndrome discHarge (TEACH) pilot study, a single-centre, double-blind, randomized controlled trial. Patients hospitalized for ACS were randomized to receive either 12 weeks of motivational text messages or usual care alone. The primary outcome was an outpatient family physician or cardiologist visit (1 month, 3 months and 1 year) after discharge. Secondary outcomes included emergency department visits, all-cause rehospitalization, all-cause mortality, medication adherence, and cardiac testing. RESULTS The study cohort included 228 patients enrolled within 12 months, with 113 assigned to the texting group and 115 to the control group. The mean age was 61.5 years, 78.5% were men, and 53.9% were White patients. At 1 month, 75.2% of patients in the intervention group and 83.5% in the usual care group had a family physician follow-up (p=0.123). Cardiologist follow-up rates at 1 month were also similar between groups, with 74.3% in the intervention group and 73.0% in the usual care group (p=0.825). There were no significant differences in physician follow-up at 3 months and 1 year. Secondary outcomes including hospitalization, emergency department use, diagnostic testing, and medication adherence, were also not significantly different between the two groups. CONCLUSIONS In this pilot randomized controlled trial, we demonstrated the ability to enroll ACS patients in a 12-week mobile motivational text messaging intervention. The texting intervention did not significantly improve rates of physician follow-up, medication adherence, or clinical outcomes in ACS patients. CLINICALTRIAL ClinicalTrials.gov ID NCT05628337