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Text messages supporting secondary CVD prevention yielded modest BP change: CHAT
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The use of text messaging via smartphone as a means of supporting secondary prevention in patients with CHD did not lead to a significant reduction in BP after 6 months compared with usual care, but the mobile intervention was feasible and accepted by the patients, according to findings presented during the American Heart Association Quality of Care and Outcomes Research Scientific Sessions.
Xin Zheng, MD, PhD, and colleagues conducted the CHAT study to evaluate whether tailored a culturally-sensitive text messaging intervention supporting secondary prevention would improve risk factor control in patients with CHD in China.
“Text messaging is increasingly recognized as a means of engaging patients, changing behaviors and modifying risk factors,” Zheng, of the National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, Beijing, China, and colleagues wrote in the study, which was simultaneously published in Circulation: Cardiovascular Quality and Outcomes. “Numerous studies have demonstrated that, in particular populations, text messaging may have salutary effects for relatively little marginal cost.”
The researchers enrolled 822 patients with a history of MI or PCI but without diabetes (mean age, 56 years; 14% women) from 37 hospitals in China from August 2016 to March 2017.
“China is an ideal setting for a text messaging intervention focused on cardiovascular disease. Mobile devices are common throughout the population, even among older individuals. With the increasing burden of cardiovascular risk factors in China, a country with constrained resources, there is significant opportunity to trial the feasibility and effectiveness of text messaging interventions,” the researchers wrote.
The single-center, masked, randomized controlled trial evaluated a control group, which received two automated text messages per month in addition to usual care, and the intervention group, which received six text messages per week for 6 months in addition to usual care. The text messages provided educational and motivational information related to disease-specific knowledge, risk factor control, physical activity and medication adherence. All patients also received personalized welcome text messages, birthday greetings and follow-up reminders during the study period. While patients were not expected to reply, patient engagement via text message was encouraged.
The primary endpoint was change in systolic BP from baseline to 6 months. At 6 months, systolic BP was not significantly lower in the intervention group compared with the control group (mean change, 3.2 mm Hg vs. 2 mm Hg; P > .05; mean net change, –1.3 mm Hg; 95% CI, –3.3 to 0.8).
Additionally, there were no significant changes between the intervention and control group in secondary endpoints including smoking status, LDL, physical activity or BMI.
However, 96% of patients in the intervention group reported the text messages were useful, 99% said they was easy to understand, 94% felt they were appropriate in frequency and 95% were willing to receive future text messages.
“The findings in our study suggest that text messaging can achieve modest effects in risk factor control, though more studies are needed on how best to optimize the intervention to achieve the desired impact,” Zheng and colleagues wrote. “Our study has paved the way to make mHealth technology-based intervention embedded into practice as an innovational model of care.”
Jessica R. Golbus, MD , of the division of cardiovascular diseases in the department of internal medicine at the University of Michigan in Ann Arbor, Brahmajee K. Nallamothu, MD, professor in the division of cardiovascular diseases and the department of internal medicine at the University of Michigan, and Predrag Klasna, PhD, assistant professor of information in the School of Information at the University of Michigan, discussed the new CHAT data in light of other studies in a related editorial.
The editorial authors noted that CHAT “was designed to mirror the TEXT ME trial, which was conducted in Australia and demonstrated significant differences in LDL and systolic BP at 6 months. While the CHAT and TEXT ME trials highlight a different overall result of a text messaging intervention, “the marked differences between study results are instructive, however, in that they highlight the importance of studying mHealth interventions in each population in which they will be introduced,” they wrote.
“This is a critical step for digital health technology and shows the potential to disrupt healthcare delivery. Yet, further development is obviously needed before it can deliver personalized and effective care for the masses. Evaluation of mHealth interventions like the CHAT trial help us shift from just ‘talking the talk’ to ‘walking the walk.’” – by Earl Holland Jr
References:
Zheng X, et al. Poster No. 293. Presented at: AHA Quality of Care and Outcomes Research Scientific Sessions; April 5-6, 2019; Arlington, Va.
Golbus J, et al. Circ Cardiovasc Qual Outcomes. 2019;doi: 10.1161/CIRCOUTCOMES.119005643.
Disclosures: Zheng, Golbus and Nallamothu reported no relevant financial disclosures. Cardiology Today could not confirm Klasna’s relevant financial disclosures at the time of publication. Please see the study for all other authors’ relevant financial disclosures.