- A new study suggests that receiving personalized SMS text “nudges” about prescriptions could help improve medication adherence and reduce readmission.
- The study involved heart failure patients at Magnolia Regional Health Center, addressing a critical gap in heart failure care.
- The retrospective analysis indicates strong acceptance of the intervention among a majority of participants, with benefits for adherence.
Heart failure (HF) is the inability of the heart to pump enough blood around the body. According to research, the lifetime risk of HF is increasing, and roughly 1 in 4 persons will develop HF in their lifetime.
A doctor can prescribe a variety of medications for HF. However, medication nonadherence represents a common problem that can compromise health. Studies from 2023 and 2025 both highlight inadequate adherence to HF medication, with 47% and 43.6% of individuals, respectively, not taking HF medication as prescribed.
“Medication nonadherence is a major and underappreciated problem in heart failure care,” Kevin Shah, MD, board certified cardiologist and Program Director of Heart Failure Outreach at MemorialCare Heart & Vascular Institute at Long Beach Medical Center in Long Beach, CA, who was not involved in the study, told Medical News Today.
“Even when we prescribe highly effective therapies, many patients struggle to take them consistently or to refill them on time. The consequences are significant. Heart failure is a condition where small lapses in therapy can translate into worsening symptoms…adherence is a core part of effective heart failure treatment.”
A collaborative study by Magnolia Regional Health Center in Mississippi and health technology company DrFirst, suggests that automated text message reminders may help people with HF better manage their medications and reduce the risk of returning to the hospital shortly after discharge.
The retrospective analysis was recently published in PLOS Digital Health.
The study analyzed data from 1,276 patients with HF over a 27-month period. Researchers compared outcomes between patients who interacted with SMS text “nudges” containing prescription information and those who did not engage with the messages.
According to the results, patients engaging with the text messages had 19% higher odds of filling their prescribed medications. They also experienced a 6% reduction in the odds of hospital readmission within 30 days of discharge.
HF is a leading cause of hospitalization in the United States, and medication nonadherence remains a persistent challenge. As such, text-based interventions may help to combat avoidable complications and hospital readmissions.
Speaking to MNT, Weston Blakeslee, PhD, VP of Clinical Intelligence at DrFirst and co-author of the study, discussed the rationale for the study.
“When patients struggle with medication adherence after discharge, it can trigger a cascade of complications such as worsening symptoms, emergency department visits, and hospital readmissions. We recognized that even modest improvements in adherence could prevent many of these downstream effects.”
“…Magnolia Regional Health Center serves a substantial number of patients with CHF and already has systems in place to track prescription fill rates,” he continued.
“This created a unique opportunity to test whether an intervention that enabled patients to view information about their medications via text notifications could make a meaningful difference for this vulnerable population.”
The text messages were sent automatically through a platform integrated directly into the e-prescribing workflow. The platform is available through healthcare technology company DrFirst, which had current or former employees involved in the study.
Each personalized message included prescriber information and an interactive link that allowed participants to view medications sent to their pharmacy, access educational content about their prescriptions, and find copay assistance when available.
When asked about the importance of engaging with patients, Shah replied, “very important.”
“Heart failure outcomes are driven not only by the medications we choose, but by whether patients can realistically take them as intended over time. Engagement matters because nonadherence is often a complex issue including cost, side effects, or health literacy.”
“When clinicians and health systems take the time to reinforce the ‘why’ behind each medication, simplify regimens, address affordability, and build trust, adherence improves. This can reduce decompensation, avoid hospitalizations, and improve quality of life,” he continued.
Additionally, individuals did not need to download an app or create login credentials to access the information.
“As for why we chose text messaging, it is universal and simple. Nearly everyone has a mobile phone, and the messages do not require downloading an app or remembering a password,” Blakeslee explained.
“Providers can deliver well-timed, personalized medication information directly to patients in a format they are already comfortable with and use every day.”
The researchers also reported strong engagement with the text-based intervention. For example, 92% of participants clicked to view their prescription information at least once and only 7.7% opted out of receiving text notifications.
Among individuals with a prior hospitalization, those who engaged with the messages had 52% higher odds of filling prescriptions.
“Where we saw the most substantial improvement in medication adherence,” Blakeslee told us, “was in patients who were readmitted to the hospital. Their fill rates jumped from 50% to 60%, and they were 52% more likely to fill a prescription after receiving and clicking on a text message for more information.”
“It is possible that the experience of readmission served as a wake-up call, making these patients more receptive to support with their medications,” he added.
These findings indicate that text message interventions may be an acceptable and effective communication method for those with chronic conditions, particularly those who may face barriers to using more complex digital health tools.
“Providers can take the learnings from this study to adjust how they use personalized and context-specific messages,” Blakeslee noted. “For example, they might send more frequent reinforcement messages to higher risk groups.”
“…this study supports these efforts by suggesting that the most important subcohort to focus on are the patients who returned to the ED, but were not sick enough to get admitted.”
Medication nonadherence affects many people across the US and is estimated to contribute more than $500 billion in avoidable healthcare costs annually. Additionally, nonadherence may also account for up to 10% of hospital admissions.
Furthermore, adherence is a
Commenting on the study, Shah told MNT, “I think this is a promising and practical approach. Text-based reminders are relatively low-cost, scalable, and can meet patients where they are in their daily routines.”
“Small ‘nudges’ can help close the gap between a prescription being written and a medication actually being filled and taken consistently.”
“That said, reminders alone will not solve nonadherence for every patient. If the primary barrier is cost, side effects, or difficulty navigating the pharmacy system, then the intervention needs to be paired with broader support such as pharmacist involvement, care coordination, patient education, or medication access programs.”
“The best heart failure medications only work if patients can access them, understand them, and take them consistently. Thoughtful, low-friction interventions like text nudges can help bridge that real-world gap,” he concluded.
The authors of the study note that while the observed reduction in readmissions was modest, even small improvements could have meaningful impacts. This could be even more evident in rural and resource-limited healthcare settings.
“The beauty of this approach to prescription engagement is its simplicity and timing,” Blakeslee told MNT. “Patients receive messages within minutes of their doctor sending a prescription to the pharmacy, when the information is most relevant and actionable. This happens automatically, without requiring extra steps from busy clinical staff.”
Further research will look to explore whether the text-based intervention can influence additional outcomes, such as blood pressure control and long-term cardiovascular events.
