doctor drawing heart symbol at the whiteboardA new study published in the Journal of the American Medical Association has shown that a surprisingly simple text messaging program can reduce body mass index (BMI), smoking rates, blood pressure, and LDL-C levels in heart disease patients1.

Patients who have had a heart attack or other cardiovascular disease events are at high risk for recurrence and so secondary prevention strategies are critical. And like many clinicians, I also spend a lot of time singing the praises of cardiac rehabilitation to convince my patients that investing their time in these programs will be worth it. In addition to supervised exercise, these programs provide a wide range of counseling and education to help patients make difficult behavior changes, like quitting smoking or turning around their diet.

And recognizing widespread under-utilization of this resource, we’ve seen some efforts to take cardiac rehabilitation mobile.

A group of Australian researchers designed a simple text messaging based program to deliver at least some motivational support and education to heart disease patients. This program delivered four text messages per week for six months covering smoking, diet, exercising, and other cardiovascular health topics. And aside from some simple personalization strategies, like adding the patient’s name to some messages or not sending anti-smoking messages to non-smokers, messages were selected at random from a large message bank designed by clinicians and other healthcare professionals.

Figure: Study ResultsThey randomized just over 700 patients to receive this intervention or to usual care; patients were followed for six months. The benefits they found were impressive, particularly for blood pressure, for a surprisingly simple intervention. For comparison, starting a standard dose of HCTZ is estimated to lower systolic blood pressure by 8 mm Hg.

Text messaging has proven to be effective in a number of areas, such as smoking cessation and maternal-fetal health. And while the tendency in digital health interventions is to add a lot of bells and whistles, personalize like crazy, and otherwise add a lot of complexity (at least behind the scenes), this study further supports that there may be some lower hanging fruit available through text messaging programs that are simple, low-cost, and highly scalable.

It will be interesting to see what happens next with this platform. Perhaps we’ll see the text message bank used in the study become publicly available, like the one that ultimately formed the basis of the SmokefreeTXT program.