Study looks at digital approach to secondary heart attack prevention

The results, published in the American Heart Association’s journal, Circulation, show regular educational, motivational, and supportive text messages offer a small improvement in lifestyle behaviours, but have little effect on medication adherence.
 
Lead author and cardiologist at Westmead Hospital, Professor Clara Chow, said current post-hospitalisation prevention programs can be helpful but ‘even with access to these programs, about two-thirds of people do not attend due to various barriers’, including work, inflexible program hours, distance or a lack of perceived need.

Professor Chow says hospital admissions for people who have experienced a heart attack are generally short, and there may not be sufficient time to provide information and education to support their recovery and set out how to prevent another heart attack.
 
Coronary heart disease remains the leading cause of disease burden and death in Australia, and as many as one in four heart attack survivors will experience another event without intervention.
 
Looking at potential digital solutions, Professor Chow and her team led a multi-centre randomised controlled trial of more than 1400 adults hospitalised after a heart attack across 18 different hospitals throughout Australia between 2013 and 2017.
 
Following discharge, all participants received standard secondary heart attack prevention care as recommended by their treating doctor, including medications, lifestyle counselling and cardiac rehabilitation.
 
Half of the participants were also randomly assigned to receive additional educational text messages on their mobile phones.
 
Messages focused on a range of topics from blood pressure and cholesterol targets to physical activity, diet, smoking cessation, mental health and medications.
 
Messages relating to medications focused on how they worked, common side effects and the importance of taking them regularly.
 
Text messages were sent over a 12-month period, with four text messages sent each week for the first six months followed by three messages per week over the next six months, with a health counsellor regularly reviewing and responding to any replies or questions.

A user feedback survey found that 86% of respondents felt the text messaging was useful, 63% agreed the program reminded them to take their medications, 58% reported their diet became healthier, while 48% said they exercised more as a result of the messages.
 
Overall, the study found a small but significant improvement in lifestyle behaviours, with those receiving text messages more likely to have a normal body mass index level and more likely to report eating at least five servings of vegetables and two servings of fruit every day.
 
‘Even though this study found no significant impact on medication adherence, it demonstrates that a simple, low-cost and customised text message-based program can deliver systematic, post-discharge education and support to people after a heart attack with minimal staff support,’ Professor Chow said.
 
‘The lack of impact on medication adherence suggests external factors that we did not examine, such as cost, may be a factor, and barriers need to be understood and addressed in education programs.’
 
Although the study had limitations including self-reported outcomes and lack of blinding, its authors hope it will pave the way for more research into digital health solutions for secondary prevention.
 
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heart attack Secondary prevention