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TEXT ME: Program helps improve LDL, CVD risk factors in patients with CHD
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Patients with CHD assigned a service providing text messages supporting healthy lifestyle behaviors lowered their LDL level and showed greater improvement in CVD risk factors compared with those assigned the usual care, according to results from the TEXT ME study.
Researchers enrolled 710 patients with CHD (mean age, 58 years; 82% men; 53% current smokers) at a single center in Australia between September 2011 and November 2013.
They assigned patients to an intervention consisting of four text messages per week for 6 months besides the usual care (n = 352) or to the usual care alone (n = 358). The messages included advice, information and motivation for improving diet and physical activity level, as well as smoking cessation if participants were current smokers.
The primary endpoint was LDL level at 6 months, with secondary endpoints including systolic BP, BMI, physical activity level and smoking status.
Program improved indicators
Compared with controls, the intervention group had lower LDL at 6 months (intervention group, 79 mg/dL; 95% CI, 76-82; control group, 84 mg/dL; 95% CI, 81-87; mean difference, –5 mg/dL; 95% CI, –9 to 0), Clara K. Chow, MBBS, PhD, and colleagues wrote.
Chow, from The George Institute for Global Health, Sydney Medical School, University of Sydney, and Westmead Hospital, Sydney, and colleagues also found that the intervention group performed better than controls at 6 months with regard to the following risk factors:
- systolic BP: intervention group, 128.2 mm Hg; 95% CI, 126.7-129.8; control group, 135.8 mm Hg; 95% CI, 134.3-137.3; mean difference, –7.6 mm Hg; 95% CI, –9.8 to –5.4;
- BMI: intervention group, 29 kg/m2; 95% CI, 28.8-29.3; control group, 30.3 kg/m2; 95% CI, 30.1-30.5; mean difference, –1.3 kg/m2; 95% CI, –1.6 to –0.9;
- physical activity: intervention group, 936.1 metabolic equivalent (MET) minutes/week; 95% CI, 799.7-1,072.5; control group, 642.7 MET minutes/week; 95% CI, 509.2-776.2; mean difference, 293.4 MET minutes/week; 95% CI, 102-484.8; and
- current smoking: intervention group, 26%; control group, 42.9%; RR = 0.61; 95% CI, –0.48-0.76.
Most patients in the intervention group said the text messages were useful (91%), easy to understand (97%) and sent with an appropriate frequency (86%), the researchers wrote.
“The duration of these effects and, hence, whether they result in improved clinical outcomes remain to be determined,” Chow and colleagues wrote.
More work to be done
In a related editorial, Zubin J. Eapen, MD, MHS, and Eric D. Peterson, MD, MPH, wrote, “The TEXT ME study provides a good initial evaluation of a mobile health intervention but also highlights future work to be done.”
They wrote that limitations include the single-center design, self-reporting of some secondary outcomes, no evaluation of dose effect, no evaluation of the system integrated into larger prevention efforts and unknown durability of benefit.
“Creating an agile and clinically integrated research framework that rigorously evaluates all interventions — drug, device or digital — is a collective responsibility and challenge for both app developers and health care practitioners,” Eapen and Peterson, both from Duke Clinical Research Institute, concluded. – by Erik Swain
Disclosures: The researchers report no relevant financial disclosures. Eapen reports financial ties with Amgen, Cytokinetics, Janssen, Novartis and SHL Telemedicine. Peterson reports financial ties with AstraZeneca, Bayer, Boehringer Ingelheim, Merck, Sanofi and Valeant.
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