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Cochrane corner: text messaging to improve adherence to drugs for secondary prevention of cardiovascular disease
  1. Alma J Adler1,
  2. Juan P Casas2,
  3. Nicole Martin2,
  4. Caroline Free3,
  5. Pablo Perel1
  1. 1 Department of Non-Communicable Disease Epidemiology, London School of Hygiene &Tropical Medicine, London, UK
  2. 2 Institute of Health Informatics, University College London, London, UK
  3. 3 Department of Population Health, London School of Hygiene & Tropical Medicine
  1. Correspondence to Dr Alma J Adler, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; Alma.Adler{at}

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Despite numerous readily available low cost and effective medications for secondary prevention of cardiovascular disease (CVD), it has been shown that a substantial proportion of cardiovascular (CV) events in people with established atherosclerotic cardiovascular disease are due to poor adherence.1 Worldwide, at least 100 million people are thought to have prevalent heart disease, resulting in at least 13 million deaths each year. The majority of these deaths occur in low and middle income countries.2 Given the complexity of the problem and the variety of settings it occurs in, finding a feasible and scalable intervention to increase adherence poses challenges. Globally, there are over 7.5 billion mobile phone subscriptions, and even in low and middle income countries, the penetrance rate is over 90%. Some mobile short messages services (SMS) have been shown to improve medication adherence for chronic conditions such as HIV.3 SMS could be a potentially cost-effective and scalable intervention and do not require that the intended audience need to search for information as it is delivered to them, as opposed to health worker-based interventions that are more expensive and complex to deliver. SMS interventions are seen to be of particular interest in low and middle income countries, where it is difficult to deliver healthcare into rural and remote communities. SMS also has the advantage of having relatively few side effects.4 Despite great enthusiasm for using SMS-based interventions to improve adherence and improve health outcomes, the evidence is limited.5 In this summary, we report the results of a recent Cochrane review.6 While other systematic reviews have addressed the question of using mobile phones for all types …

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  • Contributors This editorial was written by AJA, J-PC, NM and PP and based on the systematic review planned, conducted and reported by them and other authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests PP has received a grant from the Medical Research Council (MRC) to develop a pilot trial to evaluate efficacy of text message to improve adherence to cardiovascular medications in secondary prevention. J-PC is the primary supervisor of a PhD student funded through an Industrial Case Engineering and Physical Sciences Research Council (EPSRC) studentship, where the industrial partner is Glaxo Smith Kline (GSK) .

  • Patient consent Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.