Text Messaging as Secondary Prevention in Coronary Heart Disease Patients

Research Highlights

Though cardiovascular disease is notorious for being the primary cause of death on the global stage, many treatment options have become available to patients. Most of these options have extensively proven to decrease the risk of dangerous cardiovascular events, especially those that involve lifestyle modifications. Though the rehabilitation programs currently in place offer support, such as education and monitoring, these programs have proven difficult to some patients due to factors such as time commitment and distance from centers. Only a maximum of one third of coronary heart disease patients utilize these centers, known as “formal secondary prevention programs”. This underutilization is problematic, as secondary prevention has been proven to control risk factors, motivate patients to maintain lifestyle changes, and promote the use of preventative drugs.  In an effort to make a cheap, accessible, and quick alternative, researchers decided to take a modern approach by utilizing text messaging to prevent cardiovascular disease.

            The trial, known as the Tobacco, Exercise, and Diet Messages (TEXT ME) trial, was performed on 710 patients with coronary heart disease, including previous myocardial infarction. 53% of the patients were smokers and 82% of the patients were men. The study took place in Sydney, Australia, from September 2013 to November 2011. 358 patients were part of a control group, which received usual care, and 352 patients were included in the intervention group, which received text messages in conjunction with usual care. Intervention group patients received 4 text messages each week for 6 months. Messages were selected from a bank of messages and delivered through an automated system. The messages included facts such as “Studies show that stress, worry & loneliness can increase the risk of heart disease”, and advice such as “Try avoiding adding salt to your foods by using other spices or herbs”. Even support was offered, for example, “[NAME], for many it may take several attempts to quit, so keep trying”.

            In order to measure the effectiveness of TEXT ME at the end of the six month trial period, researchers looking primarily at low-density lipoprotein cholesterol (LDL-C) levels. LDL-C levels were found to be significantly lower in the patients who received text messages. Other important cardiac health factors, such as smoking status, physical activity, body mass index (BMI), and systolic blood pressure, were also measured. Significant decreases in systolic blood pressure and BMI were observed in patients participating in the intervention group. Additionally, smoking habits had decreased and physical activity increased at a larger rate in the intervention patients.

            Most of the intervention patients reported positive feedback after completion of the trial.  97% of intervention patients agreed the program was easy to understand, 91% identified the text message method as useful, and 86% found the frequency of messages to be fitting. This trial does admit several limitations, such as the uncertainty of the continuation of these effects during longer periods of time, as well as whether or not these effects will translate into clinical outcomes. However, there is lot of literature to support improved clinical outcomes resulting from risk factor modification. This text messaging method still proves to be a feasible, cheap, and simple possible treatment option for lifestyle treatment in coronary heart disease patients.

JAMA. 2015;314(12):1255-1263. 

Lena Chatterjee is the 2015-2016 Research Highlights Editor.