Westmead Hospital study finds text message program improves lifestyle risk factors for heart attack survivors

A text messaging program study, TEXTMEDS, has successfully informed and supported heart attack survivors on how to prevent a second heart attack.

The randomised controlled study led by Westmead Hospital cardiologist and academic director and professor of medicine at Westmead Applied Research Centre at the University of Sydney, Dr Clara Chow, investigated whether text messages and telephone patient support could improve risk factors in people who are at high risk of subsequent cardiovascular events.

The trial was a first-of-a kind in implementing a systematic digital health intervention across about 20 hospitals across urban and rural Australia.

Approximately half of all cardiovascular disease events occur in the first year following a heart attack or stroke, with 20 to 40 per cent of these patients readmitted with a subsequent coronary event within 12 months.

To lower their risks, people who have had a heart attack are encouraged to maintain a healthy lifestyle; manage heart disease risk factors including blood pressure, cholesterol and diabetes; and take medications as prescribed by their doctor.

The TEXTMEDS study set out to improve patient adherence to medication, lifestyle and behaviour change.

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 how to prevent another heart attack,” said Dr Chow.

“Post-hospitalisation prevention programs can be helpful, however, even with access to these programs, about two-thirds of people do not attend due to various barriers including returning to work, inflexible program hours, distance or lack of perceived need.”

Participants received four text messages each week for the first six months and then three messages per week over the subsequent six months.

The digital platform developed by the research team, applied algorithms that enable selection of appropriate and personalised messages to support patients who recently suffered a heart attack across Australia. The text messages explained things such as blood pressure and cholesterol targets, how each of the medicines work and the importance of taking medications regularly. They also addressed health topics including physical activity, diet, smoking cessation, and mental health following a heart attack.

Study participants showed improvements in healthy lifestyle measures after 12 months, with text group participants found to be 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, TEXTMEDS demonstrates that a simple, low-cost and customised text message-based program can deliver systematic, post-discharge education and support people after a heart attack with minimal staff support.”

Of the 509 patients in the text message group who responded to a user feedback survey, 86 per cent agreed the text messaging program was useful and 63 per cent agreed the text message program reminded them to take their medications and motivated them to change their lifestyle.

58 per cent reported that their diet became healthier due to the messages and 48 percent reported they were exercising more regularly as a result of the text messages.

The study was funded by the National Health and Medical Research Council in Australia.