Mobile phone text-messaging interventions aimed to prevent cardiovascular diseases (Text2PreventCVD): systematic review and individual patient data meta-analysis

Abstract

BackgroundA variety of small mobile phone text-messaging interventions have indicated improvement in risk factors for cardiovascular disease (CVD). Yet the extent of this improvement and whether it impacts multiple risk factors together is uncertain. We aimed to conduct a systematic review and individual patient data (IPD) meta-analysis to investigate the effects of text-messaging interventions for CVD prevention.MethodsElectronic databases were searched to identify trials investigating a text-messaging intervention focusing on CVD prevention with the potential to modify at least two CVD risk factors in adults. The main outcome was blood pressure (BP). We conducted standard and IPD meta-analysis on pooled data. We accounted for clustering of patients within studies and the primary analysis used random-effects models. Sensitivity and subgroup analyses were performed.ResultsNine trials were included in the systematic review involving 3779 participants and 5 (n=2612) contributed data to the IPD meta-analysis. Standard meta-analysis showed that the weighted mean differences are as follows: systolic blood pressure (SBP), −4.13 mm Hg (95% CI −11.07 to 2.81, p<0.0001); diastolic blood pressure (DBP), −1.11 mm Hg (−1.91 to −0.31, p=0.002); and body mass index (BMI), −0.32 (−0.49 to −0.16, p=0.000). In the IPD meta-analysis, the mean difference are as follows: SBP, −1.3 mm Hg (−5.4 to 2.7, p=0.5236); DBP, −0.8 mm Hg (−2.5 to 1.0, p=0.3912); and BMI, −0.2 (−0.8 to 0.4, p=0.5200) in the random-effects model. The impact on other risk factors is described, but there were insufficient data to conduct meta-analyses.ConclusionMobile phone text-messaging interventions have modest impacts on BP and BMI. Simultaneous but small impacts on multiple risk factors are likely to be clinically relevant and improve outcome, but there are currently insufficient data in pooled analyses to examine the extent to which simultaneous reduction in multiple risk factors occurs.PROSPERO registration numberCRD42016033236.

The Use of SMS Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2Prevent): Results From a Pilot Randomized Controlled Trial

“…SMS text messages also have the benefits of being able to store messages that can be reaccessed, have a wide geographic reach, are convenient due to the asynchronous nature of communication, and have low delivery costs. Previous SMS text messaging studies in patients with or at risk for cardiovascular disease (CVD) have reported improvements in self-management behaviors (eg, medication adherence [ 22 ] and increases in leisure physical activity and walking [ 23 ]) and cardiac risk factors (eg, lowering low-density lipoprotein cholesterol and systolic blood pressure [ 24 , 25 ]). These studies show the promise of using SMS text messaging to aid in the care of patients with CVD.…”

2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society

“… 14 , 15 Available evidence is limited by short-term follow-up and self-reported adherence (Shariful Islam 2019). 16 Success may depend on personalized messages with tailored advice, the ability to respond to texts, timing messages to coincide with medication doses, higher frequency of messages, and the use of additional apps or websites (Park 2014). 17 Interoperability with the electronic medical record (EMR) may facilitate this approach.…”

2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

“…Text messaging was shown to increase medication adherence and improved cardiovascular risk factors 208,209 . Available evidence is limited by short‐term follow‐up and self‐reported adherence 210 . Success may depend on personalized messages with tailored advice, the ability to respond to texts, timing messages to coincide with medication doses, higher frequency of messages, and the use of additional apps or websites 211 .…”