Texts Could Reduce Coronary Artery Disease Risk Factors

Text messages that provide advice, motivation, and support could make a difference for patients with coronary artery disease (CAD).

A new study published inJAMAexplored how a mobile health intervention could affect low-density lipoprotein cholesterol (LDL-C), systolic blood pressure, body mass index (BMI), physical activity, and smoking status.

The researchers noted that cardiovascular disease (CVD) prevention efforts—and lifestyle changes, in particular—can be powerful tools, but they’re underutilized and poorly adhered to.

The Tobacco, Exercise and Diet Messages (TEXT ME) trial involved 710 patients from a large tertiary hospital between September 2011 and November 2013. More than 80% of the patients were men, and about half were current smokers. The subjects, who had a mean age of 58 years, also had proven CAD.

Around half (352) of the patients in the intervention group received usual care, plus 4 texts per week for 6 months. The control group received only the standard care.

The texts covered topics like diet, physical exercise, smoking, and general cardiovascular information.

Some of the texts used were:

· “[Patient name], try identifying the triggers that make you want a cigarette and plan to avoid them.”

· “Did you know 90% of people don’t eat the recommended daily intake of vegetables (5 servings a day)?”

· “Hi [patient name], don’t forget physical activity is good for you! It reduces your risk of diabetes, heart attack, stroke, and their complications.”

· “Studies show that stress, worry, and loneliness can increase the risk of heart disease. Please talk to a health professional if you need help.”

After 6 months, the intervention patients had lower LDL-C levels than the control patients. In addition, they saw reductions in systolic blood pressure, smoking, and BMI, plus significant increases in physical activity.

However, the researchers noted that the “duration of these effects and hence whether they result in improved clinical outcomes remain to be determined.”

The patients in the texting group reported that the program was useful and easy to understand. Around 80% of them said the texts were motivating in terms of dieting, and 73% said the texts encouraged them to make physical activity changes.

Text messaging can be a low-cost mobile health intervention. The researchers reported that they spent around $0.10 per message, and less than $10 was spent on each intervention patient during the 6-month program. They also noted that the texts were easily automated.

“Mobile phone interventions that focus on text messaging have particular value, because they do not require a smartphone and are agnostic to the mobile operating system,” they added. “Furthermore, most people across all income groups own a mobile phone, so a text message-based intervention has the potential to have substantial population effects.”

One of the study’s limitations was that its focus was on the difference in risk factor outcomes, rather than actual clinical outcomes. In addition, the texts were only sent in English, and some of the patient data were self-reported.