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Original Investigation
September 22/29, 2015

Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease: A Randomized Clinical Trial

Author Affiliations
  • 1The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
  • 2Westmead Hospital, Sydney, Australia
  • 3The George Institute for Global Health, University of Sydney, Sydney, Australia
  • 4Royal Perth Hospital, Perth, Australia
  • 5University of Western Australia, Perth
  • 6Queensland University of Technology, Queensland, Australia
  • 7University of Auckland, Auckland, New Zealand
  • 8University of Sydney, Sydney, Australia
JAMA. 2015;314(12):1255-1263. doi:10.1001/jama.2015.10945
Abstract

Importance  Cardiovascular disease prevention, including lifestyle modification, is important but underutilized. Mobile health strategies could address this gap but lack evidence of therapeutic benefit.

Objective  To examine the effect of a lifestyle-focused semipersonalized support program delivered by mobile phone text message on cardiovascular risk factors.

Design and Setting  The Tobacco, Exercise and Diet Messages (TEXT ME) trial was a parallel-group, single-blind, randomized clinical trial that recruited 710 patients (mean age, 58 [SD, 9.2] years; 82% men; 53% current smokers) with proven coronary heart disease (prior myocardial infarction or proven angiographically) between September 2011 and November 2013 from a large tertiary hospital in Sydney, Australia.

Interventions  Patients in the intervention group (n = 352) received 4 text messages per week for 6 months in addition to usual care. Text messages provided advice, motivational reminders, and support to change lifestyle behaviors. Patients in the control group (n=358) received usual care. Messages for each participant were selected from a bank of messages according to baseline characteristics (eg, smoking) and delivered via an automated computerized message management system. The program was not interactive.

Main Outcomes and Measures  The primary end point was low-density lipoprotein cholesterol (LDL-C) level at 6 months. Secondary end points included systolic blood pressure, body mass index (BMI), physical activity, and smoking status.

Results  At 6 months, levels of LDL-C were significantly lower in intervention participants (mean difference, −5 mg/dL [95% CI, −9 to 0]; P = .04). There were concurrent reductions in systolic blood pressure (−7.6 mm Hg [95% CI, −9.8 to −5.4]; P < .001) and BMI (−1.3 [95% CI, −1.6 to −0.9]; P < .001), significant increases in physical activity (+345 metabolic equivalent task min/wk [95% CI, 195 to 495]; P < .001), and a significant reduction in smoking (26% vs 44%; relative risk, 0.61 [95% CI, 0.48 to 0.76]; P < .001). The majority reported the text-message program to be useful (91%), easy to understand (97%), and appropriate in frequency (86%).

Conclusions and Relevance  Among patients with coronary heart disease, the use of a lifestyle-focused text messaging service compared with usual care resulted in a modest improvement in LDL-C level and greater improvement in other cardiovascular disease risk factors. The duration of these effects and hence whether they result in improved clinical outcomes remain to be determined.

Trial Registration  anzctr.org.au Identifier: ACTRN12611000161921

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