The utility of mobile phone in the prevention of coronary heart disease, through lifestyle modification: a prospective, randomized, controlled clinical trial

Background. Unhealthy diet, cigarette smoking, pollution, sedentary lifestyle, and psychological factors such as depression and anxiety are among the major modifiable risk factors for coronary artery disease (CAD). Mobile phone text messaging (SMS) holds promise as an affordable, effective and far reaching means to effect behavioral changes in health education, and health care management. Objective. This randomized clinical trial explored the effectiveness of a SMS intervention program for improving major risk factors among (CAD) patients and their care-givers. Methodology. This randomized clinical trial was conducted in 3 cardiac specific tertiary care hospitals in Karachi, Pakistan. Participants were patients who had their first cardiac events and their respective nominated care-givers. Patients and their care-givers were randomized into two groups, intervention (IG) or usual care group with no-intervention (NIG). For the participants in the IG, daily 5 days per week, health text messages were sent to their mobile phones. Patients and their care-givers in both groups were followed up at 3 monthly intervals. Results. A total of 2656 patients and 559 care-givers were recruited. Minimum follow-up period was 180 days (range: 180 to 400 days). Baseline characteristics of participants in intervention and non-intervention group were similar in patients and caregivers. Analysis revealed that motivational psychological wellbeing SMS messages through mobile phone does not have any significant effect in promoting psychological wellbeing. There were 41 deaths in intervention and 45 deaths in non-intervention groups (total 86). The mean survival time (534 days) in intervention group and mean survival time (514 days) in non-intervention was not significantly different. Conclusions. A novel approach was adopted by recruiting caregivers as a parallel group along with their respective CAD patients. SMS text messaging alone was not effective in improving the psychological wellbeing of our study participants. Future studies with such populations may explore augmenting SMS with brief face-to-face counselling sessions. Probably, any intervention to prevent CAD will not be successful, unless there is a conducive environment provided by the government to adopt and afford the healthy lifestyle by every section of society in Pakistan.