Amazing health effects of texting people with significant cardiovascular disease. This is Healthcare Triage News.

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Our story today is from JAMA. Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease: A Randomized Controlled Trial. Researchers looked at patients with coronary heart disease being treated at a tertiary care center in Australia. They had to be older than 18 years and have one of the following: a prior myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention, or at least 50% stenosis in at least 1 major epicardial vessel.

Participants were randomized into one of two groups. The first got usual care. The second got usual care but also received semi-personalized texts messages which were tailored to provide advice, motivation, and information that aimed to help them change their diet, be more active, or quit smoking if they were. They got 4 text messages a week for 24 weeks. These were sent on 4 of 5 randomly selected weekdays at random times during the day. The messages were not interactive, and they were told not to respond to them. They could stop getting the messages at any time. And of the 341 patients in the intervention group, only 7 asked to stop getting them, 4 didn't like them, 1 developed comorbidities, 1 moved to another country, and 1 went on vacation. All participants were assessed at baseline and at 6 months for LDL cholesterol, systolic blood pressure, BMI, physical activity, and smoking status.

Let's pause a minute here. If you'd ask me to bet I would have put up all the money in my pocket on this being a negative trial. I mean random text messages, one way communication, that's all!? No way would this make a difference. I was wrong. LDL cholesterol was 5 points lower in those in the intervention (79 milligrams per deciliter versus 84), and it started higher in the intervention group. Systolic blood pressure was 8 points lower (128 milligrams of mercury versus 136). BMI was 1.3 points lower (28 versus 30.3). Physical activity was way up (936 metabolic equivalent task minutes per week versus 643). Even the percentage of people smoking was way down, 26% versus 43%. Before the trial, 53% of participants were smoking. I mean, the NNT for this intervention just for smoking cessation is less than 6! It's crazy!

They estimated the cost of this program to be about $10 for the 96 messages sent out. You could automate this easily. You don't even need a smartphone to get a text message. Granted this is a reasonably motivated population 'cause they were already pretty sick. But this program worked much more than usual care. It also focused only on risk factors and not actual outcomes. We should do a study on those too. And it's also possible that some of the self-reported measures might be inaccurate but most of these weren't self-measured. They are also only six month outcomes, and we don't know how much the results will stick.

But come on, this is promising! It really is! It's low cost, it's easy to do, it can work in resource limited settings. If this was a drug people would be investing like crazy.

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