Motivational Texting for Heart Attack Care

Overseen By Sulagna Sarker

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Sunnybrook Health Sciences Centre

Disqualifiers: Inability to consent, others

Compensation: Varies

Number of Visits: Unknown

Duration: 12 months

241 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Motivational Texting for Heart Attack Care?

Research shows that text messaging interventions can improve health outcomes by increasing appointment attendance, adherence to treatment, and better self-management. In cardiovascular disease prevention, text messaging has been effective in promoting healthy lifestyle behaviors and improving clinical outcomes. ^{1 2 3 4 5}

Is motivational texting safe for use in humans?

Research shows that using text messaging for health interventions is generally safe, with no reports of harmful effects like misreading data or privacy issues. However, personalized messages are recommended to better meet individual needs. ^{1 3 6 7 8}

How is motivational texting different from other treatments for heart attack care?

Motivational texting is unique because it uses mobile phone text messages to support self-management and lifestyle changes, making it more accessible and cost-effective than traditional treatments. It provides personalized, frequent messages that engage patients in their care, which can lead to better health outcomes. ^{1 3 9 10 11}

What is the purpose of this trial?

Although there have been substantial advances in the treatment of heart disease, heart attacks remain one of the leading causes of death and suffering around the world. Each year, more than 80,000 patients are hospitalized with heart attacks or related conditions in Canada. Even after discharge, patients are at high risk of having complications such that almost one in two patients after a heart attack will be readmitted to hospitals within the first year. Given the shortage of doctors and allied health care professionals, there is an emerging focus of digital health as a way to improve the care and outcomes after heart attacks. With more than 30 million cell phone users across Canada and almost all are already using text message services, the goal of this study is to conduct a pilot test using an innovative clinical trial design to see if the care and outlook of heart attack patients using mobile text messages can be improved.

Research Team

Dennis Ko, MD

Principal Investigator

Research Director

Eligibility Criteria

This trial is for heart attack patients over 18 who were treated at Sunnybrook Hospital, have a cellphone with texting, and can read and respond to English texts. It's not for those who can't consent in English or lack SMS-capable phones.

Inclusion Criteria

I was admitted to Sunnybrook Hospital with a heart attack or related condition.

I am older than 18 years.

Access to a cellphone that can receive text messages

Exclusion Criteria

I cannot give consent in English.

You don't have a cellphone that can send and receive text messages.

Inability to read or answer English texts

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive mobile text message-based interventions to improve care transitions after hospitalization with heart attack

12 months

Ongoing virtual interactions via text messages

Follow-up

Participants are monitored for medication compliance, re-hospitalization, and emergency department presentations

12 months

Data collection through existing registries and databases

Treatment Details

Interventions

• Control
• Motivational texting
• Texting intervention

Trial Overview The TEACH pilot trial tests if motivational text messages after hospital discharge can improve care for heart attack patients. Participants are randomly assigned to receive these texts or be in a control group without them.

Participant Groups

Group I: Texting intervention group Experimental Treatment 1 Intervention

Subjects will receive specific health-related texts

Group II: Control group Placebo Group 1 Intervention

Subjects will receive general text messages without health information

Who Is Running the Clinical Trial?

Sunnybrook Health Sciences Centre

Lead Sponsor

Trials

693

Recruited

1,569,000+

Findings from Research

This study aims to evaluate the effectiveness of different reminder methods (text messages, reminder calls, or both) in increasing the use of service referrals among 300 participants from community outreach programs.

The research will help determine how mobile phone-based interventions can enhance community engagement and service utilization, potentially guiding future reminder protocols for similar programs across the country.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Research Protocol to Test the Effectiveness of Text Messaging and Reminder Calls to Increase Service Use Referrals in a Community Engagement Program. Varma, DS., Hart, M., McIntyre, DS., et al.[2020]

Text messaging interventions for health behaviors showed good acceptance and early efficacy, with 10 out of 16 randomized controlled trials reporting significant improvements in areas like medication adherence and behavior modification.

Despite promising results, the overall evidence is limited by methodological issues, indicating that more rigorous studies are needed to draw definitive conclusions about the effectiveness of text messaging in health interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions. Wei, J., Hollin, I., Kachnowski, S.[2022]

A systematic review of studies from 2002-2016 found that 79% of the 28 studies showed that mobile health interventions, like text messaging and apps, effectively improve cardiovascular disease (CVD) outcomes.

Personalized messages, higher engagement through two-way communication, and using multiple methods were key factors in the success of these interventions, with text messaging proving to be more effective than smartphone apps.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mobile Phone Interventions for the Secondary Prevention of Cardiovascular Disease. Park, LG., Beatty, A., Stafford, Z., et al.[2022]

Mobile healthcare technologies, specifically SMS interventions, can enhance communication between healthcare providers and patients, potentially improving post-operative care for abdominal surgical patients.

Implementing SMS for timely self-reported assessments may help prevent complications and reduce the risk of hospital readmissions, addressing the challenges faced by nurses in providing adequate pre- and post-operative instructions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

TextWithSurgeryPatients - A Research Hypothesis in Enhancing Education and Physical Assessment for Abdominal Surgical Patients. Hansen, M.[2018]

The study developed 200 motivational text messages in English and Spanish aimed at encouraging physical activity among low-income, minority patients with diabetes and depression, using an iterative design process that incorporated participant feedback and expert review.

The final selection included 54 messages that were well-received and categorized effectively, demonstrating the importance of user-centered design in creating health interventions tailored to diverse populations with low health literacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing Messaging Content for a Physical Activity Smartphone App Tailored to Low-Income Patients: User-Centered Design and Crowdsourcing Approach. Pathak, LE., Aguilera, A., Williams, JJ., et al.[2021]

A machine learning program was developed to triage SMS text message replies in health interventions, achieving high accuracy (AUC 0.86) in identifying which messages required staff review, potentially reducing the workload for health professionals.

Implementing this ML program could enhance the cost-effectiveness and scalability of SMS-based health interventions by decreasing the number of messages needing manual review, thus allowing for broader reach without significantly increasing staffing costs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of a Machine Learning Program to Correctly Triage Incoming Text Messaging Replies From a Cardiovascular Text-Based Secondary Prevention Program: Feasibility Study. Lowres, N., Duckworth, A., Redfern, J., et al.[2021]

A systematic review of nine trials involving 3779 participants found that mobile phone text-messaging interventions can lead to modest reductions in blood pressure and body mass index, indicating potential benefits for cardiovascular disease prevention.

While the standard meta-analysis showed significant improvements in systolic and diastolic blood pressure and BMI, the individual patient data meta-analysis did not find statistically significant changes, suggesting that while there are benefits, they may be smaller than initially thought.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mobile phone text-messaging interventions aimed to prevent cardiovascular diseases (Text2PreventCVD): systematic review and individual patient data meta-analysis. Shariful Islam, SM., Farmer, AJ., Bobrow, K., et al.[2021]

A systematic review of 12 studies involving text messaging interventions for behavior change found that 8 out of 9 sufficiently powered studies supported its effectiveness in promoting health behavior changes over periods ranging from 3 to 12 months.

The review highlighted the need for more research in developing countries, as most studies were conducted in developed nations, despite the potential for text messaging to be a low-cost health intervention globally.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Text messaging as a tool for behavior change in disease prevention and management. Cole-Lewis, H., Kershaw, T.[2022]

A systematic review and meta-analysis of six randomized controlled trials involving 1,158 patients found that text message interventions had no significant effect on self-management outcomes for coronary heart disease, including self-efficacy and various health metrics like LDL and BMI.

The study concluded that using text messages as a method to improve treatment adherence and control risk factors in coronary heart disease patients does not provide any positive benefits compared to usual care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Impact of Text Message On Self-Management for Coronary Heart Disease: A Meta-Analysis of Randomized Controlled Trials. Wan, Y., Wu, X., Kou, Y.[2020]

In a study involving 229 patients with Type 2 diabetes and coronary heart disease, a 6-month lifestyle-focused text messaging intervention significantly reduced systolic blood pressure by an average of 7.6 mmHg and diastolic blood pressure by 3.7 mmHg compared to usual care.

The text messaging intervention also led to a significant reduction in body mass index (BMI) by 0.89 kg/m² and waist circumference by 3.98 cm, demonstrating its effectiveness in managing cardiovascular risk factors in patients with T2DM.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of lifestyle focused text messaging on risk factor modification in patients with diabetes and coronary heart disease: A sub-analysis of the TEXT ME study. Haider, R., Hyun, K., Cheung, NW., et al.[2019]

A study involving 879 patients with coronary heart disease showed that a 1-way SMS text messaging program significantly improved lifestyle factors such as physical activity, healthy diet, and medication adherence over 6 months, helping patients manage their cardiovascular disease risk.

While the SMS intervention did not lead to significant changes in physiological measures like LDL cholesterol, systolic blood pressure, or BMI, it was well-received by participants, indicating its potential as an affordable tool for lifestyle modification in preventing cardiovascular disease recurrence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

mHealth Interventions for Lifestyle and Risk Factor Modification in Coronary Heart Disease: Randomized Controlled Trial. Bae, JW., Woo, SI., Lee, J., et al.[2021]

References

1. Canada pubmed.ncbi.nlm.nih.gov

A Research Protocol to Test the Effectiveness of Text Messaging and Reminder Calls to Increase Service Use Referrals in a Community Engagement Program. [2020]

2. England pubmed.ncbi.nlm.nih.gov

A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Mobile Phone Interventions for the Secondary Prevention of Cardiovascular Disease. [2022]

4. Netherlands pubmed.ncbi.nlm.nih.gov

TextWithSurgeryPatients - A Research Hypothesis in Enhancing Education and Physical Assessment for Abdominal Surgical Patients. [2018]

5. Canada pubmed.ncbi.nlm.nih.gov

Developing Messaging Content for a Physical Activity Smartphone App Tailored to Low-Income Patients: User-Centered Design and Crowdsourcing Approach. [2021]

6. Canada pubmed.ncbi.nlm.nih.gov

Use of a Machine Learning Program to Correctly Triage Incoming Text Messaging Replies From a Cardiovascular Text-Based Secondary Prevention Program: Feasibility Study. [2021]

7. England pubmed.ncbi.nlm.nih.gov

Mobile phone text-messaging interventions aimed to prevent cardiovascular diseases (Text2PreventCVD): systematic review and individual patient data meta-analysis. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Text messaging as a tool for behavior change in disease prevention and management. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

The Impact of Text Message On Self-Management for Coronary Heart Disease: A Meta-Analysis of Randomized Controlled Trials. [2020]

10. Ireland pubmed.ncbi.nlm.nih.gov

Effect of lifestyle focused text messaging on risk factor modification in patients with diabetes and coronary heart disease: A sub-analysis of the TEXT ME study. [2019]

11. Canada pubmed.ncbi.nlm.nih.gov

mHealth Interventions for Lifestyle and Risk Factor Modification in Coronary Heart Disease: Randomized Controlled Trial. [2021]