Intervention through semi-personal text messages encouraging risk factor modification may produce a “significant positive impact” in low-density lipoprotein cholesterol (LDL-C) levels, systolic blood pressure, body mass index and other areas in patients suffering from coronary heart disease (CHD), according to a study published Sept. 22 in the Journal of the American Medical Association.

The single-blind, randomized clinical trial based in Sydney, Australia, observed 710 patients (82 percent men; 53 percent current smokers; mean age of 58), with proven CHD between September 2011 and November 2013. The patients in the intervention group received four text messages per week for six months in addition to usual care. The text messages provided advice, motivational reminders and additional support to change lifestyle behaviors. The messages for each participant were selected from a bank of messages and delivered through an automated message management system.

Following the seven-month trial period, results showed that levels of LDL-C were significantly lower in patients who received the aforementioned text messages. The authors found that, “28.9 percent of participants in the intervention group versus 10.3 percent of participants in the control group achieved target levels for four or more key risk factors.” Further, the intervention participants were more likely to control their blood pressure, exercise more regularly and achieve nonsmoking status.

The authors note that utilizing this technology is cost effective, since the 96 text messages sent over the course of the study only cost $10 collectively. Moving forward, the authors conclude that researchers should continue to explore the benefits of intervention through digital messaging; health care technology developers should continue to innovate and create digital intervention programs; and practicing physicians should consider implementing low-cost automated programs, specifically to physicians in low-income areas.

“Health care needs to be challenged to make its evaluation as nimble as that of technology,” write Zubin J. Eapen, MD, MHS, and Eric D. Peterson, MD, MPH, FACC, of the Duke Clinical Research Institute, Durham, NC, in an accompanying editorial comment. “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. Solving this dilemma can enable the development and use of pragmatic, scalable and evidence-based solutions that can address a massive problem like cardiovascular disease.”

Keywords: Blood Pressure, Blood Pressure Determination, Body Mass Index, Cholesterol, Cholesterol, LDL, Coronary Disease, Exercise, Life Style, Lipoproteins, LDL, Text Messaging

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