title: Electronic messaging support service programs improve adherence to lipid-lowering therapy among outpatients with coronary artery disease: an exploratory randomised control study. 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abstract: AIMS AND OBJECTIVES To compare drug adherence to lipid-lowering therapy among out patients with coronary artery disease who received information via short message service , via short message service and Micro Letter , or via phone only .  BACKGROUND Messaging applications and short message service are commonly used internationally . However , little is known about how coronary artery disease out patients in China may benefit from receiving health education through these technologies . DESIGN R and om sampling method . METHODS Data were collected from March-December 2013 . Subjects from Chengdu City , China , were r and omised to three groups : short message service , short message service + Micro Letter , and phone ( control ) . Appointment reminders and health information were delivered to patients in accordance with design ations . After six months , adherence to statin prescriptions was compared among the groups by using the Morisky Medication Adherence Scale . Logistic regression analysis was applied to determine those independent variables that were related to adherence . RESULTS The short message service and short message service + Micro Letter groups had better cumulative adherence ( lower Morisky Medication Adherence Scale scores ) after six months than phone group , and the short message service + Micro Letter group had better cumulative adherence ( lower Morisky Medication Adherence Scale scores ) than the short message service group . Female sex , older age and marriage show positive associations with adherence . CONCLUSIONS Short message service and messaging applications , such as Micro Letter , are effective means of providing discharged patients with reminders and coronary artery disease-related health information . Implementation of a short message service + Micro Letter program can improve outpatient adherence to medication . RELEVANCE TO CLINICAL PRACTICE This research offers useful information to help medical staff design effective interventions to improve medication compliance among coronary artery disease patients Background Stroke is a major cause of morbidity and mortality , especially in low and middle income countries . Medical management is the mainstay of therapy to prevent recurrence of stroke . Current estimates are that only 1 in 6 patients have perfect adherence to medication schedules . Using SMS ( Short Messaging Service ) as reminders to take medicines have been used previously for diseases such as diabetes and HIV with moderate success . We aim to explore the effectiveness and acceptability of SMS in increasing adherence to medications in patients with stroke . Methods This will be a r and omized , controlled , assessor blinded single center superiority trial . Adult participants with access to a cell phone and a history of stroke longer than 1 month on multiple risk modifying medications will be selected from Neurology and Stroke Clinic . They will be r and omized into two parallel groups in a 1:1 ratio via block technique with one group receiving the st and ard of care as per institutional guidelines while the parallel group receiving SMS reminders for each dose of medicine in addition to the st and ard of care . In addition intervention group will receive messages for lifestyle changes , medication information , risk factors and motivation for medication adherence . These will bemodeled on Social Cognitive Theory and Health Belief Model and will be categorized by Michies Taxonomy of Behavioral Change Communication . Patient compliance to medicines will be measured at baseline and then after 2 months in each group by using the Morisky Medication Adherence Scale . The change in compliance to medication regimen after the intervention and the difference between the two groups will be used to determine the effectiveness of SMS reminders as a tool to increase medication compliance . The acceptability of the SMS will be determined by a tool design ed for this study whose attributes are based Rogers Diffusion of innovation theory . A sample size of 86 participants in each arm will be sufficient to detect a difference of 1 point on the MMAS with a power of 90 % and significance level of 5 % between the two groups ; using an attrition rate of 15 % , 200 participants in all will be r and omized . Discussion The SMS for Stroke Study will provide evidence for feasibility and effectiveness of SMS in improving post stroke medication adherence in an LMIC setting .Trial registration https:// clinical trials.gov/ct2/show/NCT01986023 11 Background Although supporting lifestyle change is an effective way of preventing further events in people with cardiovascular disease , providing access to such interventions is a major challenge . This study aims to investigate whether simple reminders about behaviour change sent via mobile phone text message decrease cardiovascular risk . Methods and analysis R and omised controlled trial with 6 months of follow-up to evaluate the feasibility , acceptability and effect on cardiovascular risk of repeated lifestyle reminders sent via mobile phone text messages compared to usual care .  A total of 720 patients with coronary artery disease will be r and omised to either st and ard care or the TEXT ME intervention . The intervention group will receive multiple weekly text messages that provide information , motivation , support to quit smoking ( if relevant ) and recommendations for healthy diets and exercise . The primary end point is a change in plasma low-density lipoprotein cholesterol at 6 months . Secondary end points include a change in systolic blood pressure , smoking status , quality of life , medication adherence , waist circumference , physical activity levels , nutritional status and mood at 6 months . Process outcomes related to acceptability and feasibility of TEXT ME will also be collected . Ethics and dissemination Primary ethics approval was received from Western Sydney Local Health Network Human Research Ethics Committee — Westmead . Results will be disseminated via the usual scientific forums including peer- review ed publications and presentations at international conferences . Clinical trials registration number ACTRN12611000161921 Aim To determine the effectiveness and cost-effectiveness of a mobile phone intervention to improve exercise capacity and physical activity behaviour in people with ischaemic heart disease ( IHD ) . Methods and results In this single-blind , parallel , two-arm , r and omized controlled trial adults ( n = 171 ) with IHD were r and omized to receive a mobile phone delivered intervention  ( HEART ; n = 85 ) plus usual care , or usual care alone ( n = 86 ) . Adult participants aged 18 years or more , with a diagnosis of IHD , were clinical ly stable as out patients , able to perform exercise , able to underst and and write English , and had access to the Internet . The HEART ( Heart Exercise And Remote Technologies ) intervention involved a personalized , automated package of text messages and a secure website with video messages aim ed at increasing exercise behaviour , delivered over 24 weeks . All participants were able to access usual community-based cardiac rehabilitation , which involves encouragement of physical activity and an offer to join a local cardiac support club . All outcomes were assessed at baseline and 24 weeks and included peak oxygen uptake ( PVO2 ; primary outcome ) , self-reported physical activity , health-related quality of life , self-efficacy and motivation ( secondary outcomes ) . Results showed no differences in PVO2 between the two groups ( difference −0.21 ml kg−1 min−1 , 95 % CI : −1.1 , 0.7 ; p = 0.65 ) at 24 weeks . However significant treatment effects were observed for selected secondary outcomes , including leisure time physical activity ( difference 110.2 min/week , 95 % CI : −0.8 , 221.3 ; p = 0.05 ) and walking ( difference 151.4 min/week , 95 % CI : 27.6 , 275.2 ; p = 0.02 ) . There were also significant improvements in self-efficacy to be active ( difference 6.2 % , 95 % CI : 0.2 , 12.2 ; p = 0.04 ) and the general health domain of the SF36 ( difference 2.1 , 95 % CI : 0.1 , 4.1 ; p = 0.03 ) at 24 weeks . The HEART programme was considered likely to be cost-effective for leisure time activity and walking . Conclusions A mobile phone intervention was not effective at increasing exercise capacity over and above usual care . The intervention was effective and probably cost-effective for increasing physical activity and may have the potential to augment existing cardiac rehabilitation services Background Despite the known positive effects of cardiac rehabilitation and an active lifestyle , evidence is emerging that it is difficult to attain and sustain the minimum recommendations of leisure time physical activity . The long-term benefits are often disappointing due to lack of adherence to the changes in life style . Qualitative research on patients ’ perspectives suggests that motivation for lifestyle change tends to diminish around 3 months after the index-event . The time most cardiac rehabilitation programmes end . The aim of the present study is to determine if prolongation of a traditional cardiac rehabilitation programme with additional heart rate based telemonitoring guidance for a period of 6 months results in better long term effects on physical and mental outcomes , care consumption and quality of life than traditional follow-up . Methods In this single centre r and omised controlled trial 120 patients with an absolute indication for cardiac rehabilitation will be r and omised in a 1:1 ratio to an intervention group with 6 months of heart rate based telemonitoring guidance or a control group with traditional follow-up after cardiac rehabilitation . The primary endpoint will be VO2peak after 12 months . Secondary endpoints are VO2peak after 6 months , quality of life , physical- , emotional- and social functioning , cardiac structure , traditional risk profile , compliance to the use of the heart rate belt and smartphone , MACE and care-consumption . Discussion The TeleCaRe study will provide insight into the added value of the prolongation of traditional cardiac rehabilitation with 6 months of heart rate based telemonitoring guidance . Trial registration Dutch Trial Register : NTR4644 ( registered 06/12/14 ) OBJECTIVES The purpose of this study was to assess the rate of death and hospitalization for heart failure ( HF ) 1 and 3 years after a r and omized trial of telephone intervention aim ed to improve education and compliance in stable patients with HF ended . BACKGROUND The long-term effects of HF programs are not well known . METHODS In all , 1,518 patients with HF were r and omized into the DIAL ( R and omized Trial of Phone Intervention in Chronic Heart Failure ) . After completion of the trial , patients were followed up to 3 years to assess major outcomes . Compliance with diet , weight control , and treatment was evaluated . The effect of the intervention on mortality and HF hospitalizations was assessed using relative risk ( RR ) , relative risk reduction , and Cox proportional hazards model for adjusting by potential confounders . RESULTS The rate of death or hospitalization for HF was lower in the intervention group ( 37.2 % vs. 42.6 % , RR : 0.81 , 95 % confidence interval [ CI ] : 0.69 to 0.96 ; p = 0.013 ) 1 and 3 years ( 55.7 % vs. 57.5 % , RR : 0.88 , 95 % CI : 0.77 to 1.00 ; p = 0.05 ) after the intervention ended . This benefit was mainly caused by a reduction in admission for HF ( 28.5 % vs. 35.1 % after 3 years , RR : 0.72 , 95 % CI : 0.60 to 0.87 ; p = 0.0004 ) . Patients who showed improvement in 1 or more of 3 key compliance indicators ( diet , weight control , and medication ) had lower risks of events . CONCLUSIONS The benefit observed during the intervention period persisted and was sustained 1 and 3 years after the intervention ended . This effect may be explained by the impact of the educational intervention on patients ' behavior and habits Background There is a strong will and need to find alternative models of health care delivery driven by the ever-increasing burden of chronic diseases . Objective The purpose of this 1-year trial was to study whether a structured mobile phone-based health coaching program , which was supported by a remote monitoring system , could be used to improve the health-related quality of life ( HRQL ) and /or the clinical measures of type 2 diabetes and heart disease patients . Methods A r and omized controlled trial was conducted among type 2 diabetes patients and heart disease patients of the South Karelia Social and Health Care District . Patients were recruited by sending invitations to r and omly selected patients using the electronic health records system . Health coaches called patients every 4 to 6 weeks and patients were encouraged to self-monitor their weight , blood pressure , blood glucose ( diabetics ) , and steps ( heart disease patients ) once per week . The primary outcome was HRQL measured by the Short Form ( 36 ) Health Survey ( SF-36 ) and glycosylated hemoglobin ( HbA1c ) among diabetic patients . The clinical measures assessed were blood pressure , weight , waist circumference , and lipid levels . Results A total of 267 heart patients and 250 diabetes patients started in the trial , of which 246 and 225 patients concluded the end-point assessment s , respectively . Withdrawal from the study was associated with the patients ’ unfamiliarity with mobile phones — of the 41 dropouts , 85 % ( 11/13 ) of the heart disease patients and 88 % ( 14/16 ) of the diabetes patients were familiar with mobile phones , whereas the corresponding percentages were 97.1 % ( 231/238 ) and 98.6 % ( 208/211 ) , respectively , among the rest of the patients ( P=.02 and P=.004 ) . Withdrawal was also associated with heart disease patients ’ comorbidities—40 % ( 8/20 ) of the dropouts had at least one comorbidity , whereas the corresponding percentage was 18.9 % ( 47/249 ) among the rest of the patients ( P=.02 ) . The intervention showed no statistically significant benefits over the current practice with regard to health-related quality of life — heart disease patients : beta=0.730 ( P=.36 ) for the physical component score and beta=-0.608 ( P=.62 ) for the mental component score ; diabetes patients : beta=0.875 ( P=.85 ) for the physical component score and beta=-0.770 ( P=.52 ) for the mental component score . There was a significant difference in waist circumference in the type 2 diabetes group ( beta=-1.711 , P=.01 ) . There were no differences in any other outcome variables . Conclusions A health coaching program supported with telemonitoring did not improve heart disease patients ' or diabetes patients '  quality of life or their clinical condition . There were indications that the intervention had a differential effect on heart patients and diabetes patients . Diabetes patients may be more prone to benefit from this kind of intervention . This should not be neglected when developing new ways for self-management of chronic diseases . Trial Registration Clinical Trials.gov NCT01310491 ; http:// clinical trials.gov/ct2/show/NCT01310491 ( Archived by WebCite at http://www.webcitation.org/6Z8l5FwAM ) Background Vascular disease , manifesting as myocardial infa rct ion and stroke , is a major cause of morbidity and mortality , especially in low- and middle-income countries . Current estimates are that only one in six patients have good adherence to medications and very few have sufficient health literacy . Our aim is to explore the effectiveness and acceptability of Prescription Interactive Voice Response ( IVR ) Talking Prescriptions ( Talking Rx ) and SMS reminders in increasing medication adherence and health literacy in Pakistani patients with vascular disease . Methods This is a r and omized , controlled , single center trial . Adult participants , with access to a cell phone and a history of vascular disease , taking multiple risk-modifying medications ( inclusive of anti-platelets and statins ) will be selected from cerebrovascular and cardiovascular clinics . They will be r and omized in a 1:1 ratio via a block design to the intervention or the control arm with both groups having access to a helpline number to address their queries in addition to st and ard of care as per institutional guidelines . Participants in the intervention group will also have access to Interactive Voice Response ( IVR ) technology tailored to their respective prescriptions in the native language ( Urdu ) and will have the ability to hear information about their medication dosage , correct use , side effects , mechanism of action and how and why they should use their medication , as many times as they like . Participants in the intervention arm will also receive scheduled SMS messages reminding them to take their medications . The primary outcome measure will be the comparison of the difference in adherence to anti-platelet and statin medication between baseline and at 3-month follow-up in each group measured by the Morisky Medication Adherence Scale . To ascertain the impact of our intervention on health literacy , we will also compare a local content-vali date d and modified version of Test of Health Literacy in Adults ( TOFHLA ) between the intervention and the control arm . We estimate that a sample size of 86 participants in each arm will be able to detect a difference of 1 point on the MMAS with a power of 90 % and significance level of 5 % . Accounting for an attrition rate of 15 % , we plan to enroll 100 participants in each arm ( total study population = 200 ) . We hypothesize that a linguistically tailored health IT intervention based on IVR and SMS will be associated with an improvement in adherence ( to anti-platelet and lipid-lowering medications ) and an improvement in health literacy in Pakistani patients with vascular disease . Discussion This innovative study will provide early data for the feasibility of the use of IT based prescriptions in an lower middle incorme country setting with limited numeracy and literacy skills . Trial registration Clinical Trials.gov : NCT02354040 − 2 February Background — Adherence to cardioprotective medications in the year after acute coronary syndrome hospitalization is generally poor and is associated with increased risk of rehospitalization and mortality . Few interventions have specifically targeted this high-risk patient population to improve medication adherence . We hypothesize that a multifaceted patient-centered intervention could improve adherence to cardioprotective medications . Methods and Results — To evaluate this intervention , we propose enrolling 280 patients with a recent acute coronary syndrome event into a multicenter r and omized , controlled trial . The intervention comprises4 main components : ( 1 ) pharmacist-led medication reconciliation and tailoring ; ( 2 ) patient education ; ( 3 ) collaborative care between pharmacist and primary care provider/cardiologist ; and ( 4 ) 2 types of voice messaging ( educational and medication refill reminder calls ) . Patients in the intervention arm will visit with the study pharmacist ≈1 week post-hospital discharge . The pharmacist will work with the patient and collaborate with providers to reconcile medication issues . Voice messages will augment the educational process and remind patients to refill their cardioprotective medications . The study will compare the intervention versus usual care for 12 months . The primary outcome of interest is adherence using the ReComp method . Secondary and tertiary outcomes include achievement of targets for blood pressure and low-density lipoprotein , and reduction in the combined cardiovascular end points of myocardial infa rct ion hospitalization , coronary revascularization , and all-cause mortality . Finally , we will also evaluate the cost-effectiveness of the intervention compared with usual care . Conclusions — If the intervention is effective in improving medication adherence and demonstrating a lower cost , the intervention has the potential to improve cardiovascular outcomes in this high-risk patient population Background Chronic heart failure ( HF ) disease management programs have reported inconsistent results and have not included comorbid depression management or specifically focused on improving patient-reported outcomes . The Patient Centered Disease Management ( PCDM ) trial was design ed to test the effectiveness of collaborative care disease management in improving health status ( symptoms , functioning , and quality of life ) in patients with HF who reported poor HF-specific health status . Methods / design Patients with a HF diagnosis at four VA Medical Centers were identified through population -based sampling . Patients with a Kansas City Cardiomyopathy Question naire ( KCCQ , a measure of HF-specific health status ) score of < 60 ( heavy symptom burden and impaired quality of life ) were invited to enroll in the PCDM trial . Enrolled patients were r and omized to receive usual care or the PCDM intervention , which included : ( 1 ) collaborative care management by VA clinicians including a nurse , cardiologist , internist , and psychiatrist , who worked with patients and their primary care providers to provide guideline -concordant care management , ( 2 ) home telemonitoring and guided patient self-management support , and ( 3 ) screening and treatment for comorbid depression . The primary study outcome is change in overall KCCQ score . Secondary outcomes include depression , medication adherence , guideline -based care , hospitalizations , and mortality . Discussion The PCDM trial builds on previous studies of HF disease management by prioritizing patient health status , implementing a collaborative care model of health care delivery , and addressing depression , a key barrier to optimal disease management . The study has been design ed as an ‘ effectiveness trial ’ to support broader implementation in the healthcare system if it is successful . Trial registration Unique identifier : Background Patients with cardiovascular diseases managed by a person-centered care ( PCC ) approach  have been observed to have better treatment outcomes and satisfaction than with traditional care . eHealth may facilitate the often slow transition to more person-centered health care by increasing patients ’ beliefs in their own capacities ( self-efficacy ) to manage their care trajectory . eHealth is being increasingly used , but most studies continue to focus on health care professionals ’ logic of care . Knowledge is lacking regarding the effects of an eHealth tool on self-efficacy when combined with PCC for patients with chronic heart diseases . Objective The objective of our study was to investigate the effect of an eHealth diary and symptom-tracking tool in combination with PCC for patients with acute coronary syndrome ( ACS ) . Methods This was a sub study of a r and omized controlled trial investigating the effects of PCC in patients hospitalized with ACS . In total , 199 patients with ACS aged < 75 years were r and omly assigned to a PCC intervention ( n=94 ) or st and ard treatment ( control group , n=105 ) and were followed up for 6 months . Patients in the intervention arm could choose to use a Web-based or mobile-based eHealth tool , or both , for at least 2 months after hospital discharge . The primary end point was a composite score of changes in general self-efficacy , return to work or prior activity level , and rehospitalization or death 6 months after discharge . Results Of the 94 patients in the intervention arm , 37 ( 39 % ) used the eHealth tool at least once after the index hospitalization . Most of these ( 24/37 , 65 % ) used the mobile app and not the Web-based app as the primary source of daily self-rating input . Patients used the eHealth tool a mean of 38 times during the first 8 weeks ( range 1–118 , SD 33 ) and 64 times over a 6-month period ( range 1–597 , SD 104 ) . Patients who used the eHealth tool in combination with the PCC intervention had a 4-fold improvement in the primary end point compared with the control group ( odds ratio 4.0 , 95 % CI 1.5–10.5 ; P=.005 ) . This improvement was driven by a significant increase in general self-efficacy compared with the control group ( P=.011 ) . Patients in the PCC group who did not use the eHealth tool ( n=57 ) showed a nonsignificant composite score improvement compared with those in the control group ( n=105 ) ( odds ratio 2.0 , 95 % CI 0.8–5.2 ; P=.14 ) . Conclusions We found a significant effect on improved general self-efficacy and the composite score for patients using an eHealth diary and symptom-tracking tool in combination with PCC compared with traditional care . Trial Registration Swedish registry , Research web.org , ID NR 65 791 Objective Cardiac rehabilitation ( CR ) is pivotal in preventing recurring events of myocardial infa rct ion ( MI ) . This study aims to investigate the effect of a smartphone-based home service delivery ( Care Assessment Platform ) of CR ( CAP-CR ) on  CR  use and health outcomes compared with a traditional , centre-based programme ( TCR ) in post-MI patients . Methods In this unblinded r and omised controlled trial , post-MI patients were r and omised to TCR ( n=60 ; 55.7±10.4 years ) and CAP-CR ( n=60 ; 55.5±9.6 years ) for a 6-week CR and 6-month self-maintenance period . CAP-CR , delivered in participants ’ homes , included health and exercise monitoring , motivational and educational material delivery , and weekly mentoring consultations . CAP-CR uptake , adherence and completion rates were compared with TCR using intention-to-treat analyses . Changes in clinical outcomes ( modifiable lifestyle factors , biomedical risk factors and health-related quality of life ) across baseline , 6 weeks and 6 months were compared within , and between , groups using linear mixed model regression . Results CAP-CR had significantly higher uptake ( 80 % vs 62 % ) , adherence ( 94 % vs 68 % ) and completion ( 80 % vs 47 % ) rates than TCR ( p<0.05 ) . Both groups showed significant improvements in 6-minute walk test from baseline to 6 weeks ( TCR : 537±86–584±99 m ; CAP-CR : 510±77–570±80 m ) , which was maintained at 6 months . CAP-CR  showed slight weight reduction ( 89±20–88±21 kg ) and also demonstrated significant improvements in emotional state ( K10 : median ( IQR ) 14.6 ( 13.4–16.0 ) to 12.6 ( 11.5–13.8 ) ) , and quality of life ( EQ5D-Index : median ( IQR ) 0.84 ( 0.8–0.9 ) to 0.92 ( 0.9–1.0 ) ) at 6 weeks . Conclusions This smartphone-based home care CR programme improved post-MI CR uptake , adherence and completion . The home-based CR programme was as effective in improving physiological and psychological health outcomes  as traditional CR . CAP-CR is a viable option towards optimising use of CR services . Trial registration number ANZCTR12609000251224 BACKGROUND Managing patients with heart failure ( HF ) is labor intensive , and follow-up is often inadequate to detect day-to-day changes that ultimately lead to decompensation . We tested the effect of an Internet-based telemedicine ( T ) system that provides frequent surveillance and increased communicate between HF patients and their provider on frequency of hospitalization in a cohort of patients with advanced HF . METHODS AND RESULTS HF patients in NYHA Class II-IV were r and omized to usual care ( UC , n = 24 ) or T ( T plus UC , n = 24 ) and followed for 1 year .  Office visits , emergency department visits , hospitalizations , telephone calls , and number of Internet communications were measured over the 1-year period . Left ventricular ejection fraction ( EF ) was assessed by echocardiography in both groups . For T , mean age was 53.2 + /- 2.0 years ( 72 % male , 61 % Caucasian , 39 % African American ) . For UC , mean age was 54.1 + /- 2.6 years ( 76 % male , 72 % Caucasian , 14 % African American , and 14 % Hispanic ) .  HF etiologies and EF were similar in both groups . During the 12-month period , UC had 74 total phone calls to the practice , whereas T had 88 telephone calls plus 1887 telemedicine data messages ( 6.5 messages/patient/month ) . ER visits were lower in the T group ( T 5 , UC 12 ; P < .05 ) . Hospital admissions ( T 24 , C 40 ; P = .025 ) and total hospital days ( T 84 , UC 226 days ; P < .005 ) were lower in T. Unscheduled clinic visits ( T 13 , UC 13 ; P = NS ) and scheduled clinic visits ( T 78 , UC 94 ; P = NS ) were similar in both groups . CONCLUSIONS Frequent monitoring and patient management using a telemedicine system may help to reduce hospitalizations , hospital days , and emergency department visits Background In New Zeal and , around 45,000 people live with stroke and many studies have reported that benefits gained during initial rehabilitation are not sustained . Evidence indicates that participation in physical interventions can prevent the functional decline that frequently occurs after discharge from acute care facilities . However , on-going stroke services provision following discharge from acute care is often related to non-medical factors such as availability of re sources and geographical location . Currently most people receive no treatment beyond three months post stroke . The study aims to determine if the Augmented Community Telerehabilitation Intervention ( ACTIV ) results in better physical function for people with stroke than usual care , as measured by the Stroke Impact Scale , physical subcomponent . Methods / design This study will use a multi-site , two-arm , assessor blinded , parallel r and omised controlled trial design . People will be eligible if they have had their first ever stroke , are over 20 and have some physical impairment in either arm or leg , or both . Following discharge from formal physiotherapy services ( inpatient , outpatient or community ) , participants will be r and omised into ACTIV or usual care . ACTIV uses readily available technology , telephone and mobile phones , combined with face-to-face visits from a physiotherapist over a six-month period , to help people with stroke resume activities they enjoyed before the stroke . The impact of stroke on physical function and quality of life will be assessed , measures of cost will be collected and a discrete choice survey will be used to measure preferences for rehabilitation options . These outcomes will be collected at baseline , six months and 12 months . In-depth interviews will be used to explore the experiences of people participating in the intervention arm of the study . Discussion The lack of on-going rehabilitation for people with stroke diminishes the chance of their best possible outcome and may contribute to a functional decline following discharge from formal rehabilitation . Best practice guidelines recommend a prolonged period of rehabilitation , however this is expensive and therefore not undertaken in most publicly funded centres . An effective , cost-effective , and preference-sensitive therapy using basic technology to assist programme delivery may improve patient autonomy as they leave formal rehabilitation and return home . Trial registration Remote monitoring ( RM ) of homebound heart failure ( HF ) patients has previously been shown to reduce hospital admissions . We conducted a pilot trial of ambulatory , non-homebound patients recently hospitalized for HF to determine whether RM could be successfully implemented in the ambulatory setting . Eligible patients from Massachusetts General Hospital ( n = 150 ) were r and omized to a control group ( n = 68 ) or to a group that was offered RM ( n = 82 ) . The participants transmitted vital signs data to a nurse who coordinated care with the physician over the course of the 6-month study . Participants in the RM program had a lower all-cause per person readmission rate ( mean = 0.64 , SD ± 0.87 ) compared to the usual care group ( mean = 0.73 , SD ± 1.51 ; P-value = .75 ) although the difference was not statistically significant . HF-related readmission rate was similarly reduced in participants . This pilot study demonstrates that RM can be successfully implemented in non-homebound HF patients and may reduce readmission rates Background Previous trials of telemonitoring for heart failure management have reported inconsistent results , largely due to diverse intervention and study design s. Mobile phones are becoming ubiquitous and economical , but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined . Objective The objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes . Methods One hundred patients were recruited from a heart function clinic and r and omized into telemonitoring and control groups . The telemonitoring group ( N = 50 ) took daily weight and blood pressure readings and weekly single-lead ECGs , and answered daily symptom questions on a mobile phone over 6 months . Readings were automatically transmitted wirelessly to the mobile phone and then to data servers . Instructions were sent to the patients ’ mobile phones and alerts to a cardiologist ’s mobile phone as required . Results Baseline question naires were completed and returned by 94 patients , and 84 patients returned post- study question naires . About 70 % of telemonitoring patients completed at least 80 % of their possible daily readings . The change in quality of life from baseline to post- study , as measured with the Minnesota Living with Heart Failure Question naire , was significantly greater for the telemonitoring group compared to the control group ( P = .05 ) . A between-group analysis also found greater post- study self-care maintenance ( measured with the Self-Care of Heart Failure Index ) for the telemonitoring group ( P = .03 ) . Brain natriuretic peptide ( BNP ) levels , self-care management , and left ventricular ejection fraction ( LVEF ) improved significantly for both groups from baseline to post- study , but did not show a between-group difference . However , a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the telemonitoring group had significant improvements from baseline to post- study in BNP ( decreased by 150 pg/mL , P = .02 ) , LVEF ( increased by 7.4 % , P = .005 ) and self-care maintenance ( increased by 7 points , P = .05 ) and management ( increased by 14 points , P = .03 ) , while the control group did not . No differences were found between the telemonitoring and control groups in terms of hospitalization , mortality , or emergency department visits , but the trial was underpowered to detect differences in these metrics . Conclusions Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based telemonitoring system . The use of the mobile phone-based system had high adherence and was  feasible for patients , including the elderly and those with no experience with mobile phones . Trial Registration Clinical Trials.gov Background Atrial fibrillation is a major public health problem and is the most common cardiac arrhythmia , affecting an estimated 2.7 million Americans . The true prevalence of atrial fibrillation is likely underestimated because episodes are often sporadic ; therefore , it is challenging to detect and record an occurrence in a “ real world ” setting . To date , mobile health tools that promote earlier detection and treatment of atrial fibrillation and improvement in self-management behaviors and knowledge have not been evaluated . This study will be the first to address the epidemic problem of atrial fibrillation with a novel approach utilizing advancements in mobile health electrocardiogram technology to empower patients to actively engage in their healthcare and to evaluate impact on quality of life and quality -adjusted life years . Furthermore , sending a daily electrocardiogram transmission , coupled with receiving educational and motivational text messages aim ed at promoting self-management and a healthy lifestyle may improve the management of chronic cardiovascular conditions ( e.g. , hypertension , diabetes , heart failure , etc . ) . Therefore , we are currently conducting a r and omized controlled trial to assess the efficacy of a mobile health intervention , iPhone ® Helping Evaluate Atrial fibrillation Rhythm through Technology ( iHEART ) versus usual cardiac care . Methods The iHEART study is a single center , prospect i ve , r and omized controlled trial . A total of 300 participants with a recent history of atrial fibrillation will be enrolled . Participants will be r and omized 1:1 to receive the iHEART intervention , receiving an iPhone ® equipped with an AliveCor ® Mobile ECG and accompanying Kardia application and behavioral altering motivational text messages or usual cardiac care for 6 months . Discussion This will be the first study to investigate the utility of a mobile health intervention in a “ real world ” setting . We will evaluate the ability of the iHEART intervention to improve the detection and treatment of recurrent atrial fibrillation and assess the intervention 's impact on improving clinical outcomes , quality of life , quality -adjusted life-years and disease-specific knowledge . Trial registration NCT02731326 ; Verified April Background The effectiveness of mobile technology to improve medication adherence via customized Short Messaging Service ( SMS ) reminders for stroke has not been tested in re source poor areas . We design ed a r and omized controlled trial to test the effectiveness of SMS on improving medication adherence in stroke survivors in Pakistan . Methods This was a parallel group , assessor-blinded , r and omized , controlled , superiority trial . Participants were central ly r and omized in fixed block sizes . Adult participants on multiple medications with access to a cell phone and stroke at least 4 weeks from onset ( Onset as defined by last seen normal ) were eligible . The intervention group , in addition to usual care , received reminder SMS for 2 months that contained a ) Personalized , prescription tailored daily medication reminder(s ) b ) Twice weekly health information SMS . The Health Belief Model and Social Cognitive theory were used to design the language and content of messages . Frontline SMS software was used for SMS delivery . Medication adherence was self-reported and measured on the vali date d Urdu version of Morisky Medication Adherence Question naire . Multiple linear regression was used to model the outcome against intervention and other covariates . Analysis was conducted by intention-to-treat principle . Results Two hundred participants were enrolled . 38 participants were lost to follow-up . After 2 months , the mean medication score was 7.4 ( 95 % CI : 7.2–7.6 ) in the intervention group while 6.7 ( 95 % CI : 6.4–7.02 ) in the control group . The adjusted mean difference ( Δ ) was 0.54 ( 95 % CI : 0.22–0.85 ) . The mean diastolic blood pressure in the intervention group was 2.6 mmHg ( 95 % CI ; −5.5 to 0.15 ) lower compared to the usual care group . Conclusion A short intervention of customized SMS can improve medication adherence and effect stroke risk factors like diastolic blood pressure  in stroke survivors with complex medication regimens living in re source poor areas .Trial registration Clinical trials.gov NCT01986023 last accessed at https:// clinical Background — We assessed the effect of automated treatment adherence support delivered via mobile phone short message system ( SMS ) text messages on blood pressure . Methods and Results — In this pragmatic , single-blind , 3-arm , r and omized trial ( SMS-Text Adherence Support [ StAR ] ) undertaken in South Africa , patients treated for high blood pressure were r and omly allocated in a 1:1:1 ratio to information only , interactive SMS text messaging , or usual care . The primary outcome was change in systolic blood pressure at 12 months from baseline measured with a vali date d oscillometric device . All trial staff were masked to treatment allocation . Analyses were intention to treat . Between June 26 , 2012 , and November 23 , 2012 , 1372 participants were r and omized to receive information-only SMS text messages ( n=457 ) , interactive SMS text messages ( n=458 ) , or usual care ( n=457 ) . Primary outcome data were available for 1256 participants ( 92 % ) . At 12 months , the mean adjusted change in systolic blood pressure compared with usual care was −2.2 mm Hg ( 95 % confidence interval , −4.4 to −0.04 ) with information-only SMS and −1.6 mm Hg ( 95 % confidence interval , −3.7 to 0.6 ) with interactive SMS . Odds ratios for the proportion of participants with a blood pressure < 140/90 mm Hg were 1.42 ( 95 % confidence interval , 1.03–1.95 ) for information-only messaging and 1.41 ( 95 % confidence interval , 1.02–1.95 ) for interactive messaging compared with usual care . Conclusions — In this r and omized trial of an automated adherence support program delivered by SMS text message in a general outpatient population of adults with high blood pressure , we found a small reduction in systolic blood pressure control compared with usual care at 12 months . There was no evidence that an interactive intervention increased this effect . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT02019823 . South African National Clinical Trials Register , number SANCTR DOH-27 - 1212 - 386 ; Pan Africa Trial Register , number PACTR201411000724141 Background Unintentional non-adherence has been characterized as passively inconsistent medication-taking behavior ( forgetfulness or carelessness ) . Our objectives were to : ( 1 ) study the prevalence and predictors of unintentional non-adherence ; and ( 2 ) explore the interrelationship between intentional and unintentional non-adherence in relation to patients ’ medication beliefs . Methods We conducted a cross-sectional survey of adults with asthma , hypertension , diabetes , hyperlipidemia , osteoporosis , or depression from the Harris Interactive Chronic Illness Panel . The analytic sample for this study included 24,017 adults who self-identified themselves as persistent to prescription medications for their index disease . They answered three questions on unintentional non-adherence ( forgot , ran out , being careless ) , 11 questions on intentional non-adherence , and three multi-item scales assessing perceived need for medication ( k = 10 ) , perceived medication concerns ( k = 6 ) , and perceived  medication  affordability ( k = 4 ) . Logistic regression was used to model predictors of each unintentional non-adherence behavior . Baron and Kenny ’s regression approach was used to test the mediational effect of unintentional non-adherence on the relationship between medication beliefs and intentional non-adherence . Bootstrapping was employed to confirm the statistical significance of these results . Results For the index disease , 62 % forgot to take a medication , 37 % had run out of the medication , and 23 % were careless about taking the medication . Common multivariate predictors ( p < .001 ) of the three behaviors were : ( 1 ) lower perceived need for medications ; ( 2 ) more medication affordability problems ; ( 3 ) worse self-rated health ; ( 4 ) diabetes or osteoporosis ( relative to hypertension ) ; and ( 5 ) younger age . Unique statistically-significant predictors of the three behaviors were : ( a ) ‘ forgot to take medications ’ - greater concerns about the index medication and male gender ; ( b ) ‘ run out of medications ’ - non-white race , asthma , and higher number of total prescription medications ; ( c ) ‘ being careless ’ - greater medication concerns . Mediational tests confirmed the hypothesis that the effect of medication beliefs ( perceived need , concerns , and affordability ) on intentional non-adherence is mediated through unintentional non-adherence . Conclusions For our study sample , unintentional non-adherence does not appear to be r and om and is predicted by medication beliefs , chronic disease , and sociodemographics . The data suggests that the importance of unintentional non-adherence may lie in its potential prognostic significance for future intentional non-adherence . Health care providers may consider routinely inquiring about unintentional non-adherence in order to proactively address patients ’ suboptimal medication beliefs before they choose to discontinue therapy all together BACKGROUND Non-attendance results in administrative problems and disruption in patient care . Several interventions have been used to reduce non-attendance , with varying degree of success . A relatively new intervention , text messaging , has been shown to be as effective as telephone reminders in reducing non-attendance . However , no study has looked specifically at using text messaging reminders to reduce non-attendance in chronic disease care . AIM To determine if text messaging would be effective in reducing non-attendance in patients on long-term followup , compared with telephone reminders and no reminder . DESIGN OF STUDY A r and omised controlled trial with three arms : text messaging reminder , telephone reminder , and control . SETTING Two primary care clinics in Malaysia . METHOD A total of 931 subjects who had been on at least 6 months of follow-up were r and omised into the three groups . Demographic variables were recorded at the first visit . In the intervention arms , a reminder was sent 24–48 hours prior to the appointment . Non-attendance rate was documented at the second visit . Non-attenders were defined as those who did not attend , attended early , or attended late without rescheduling their appointment . Attenders were defined as participants who had turned up for their scheduled appointment and those who had changed or cancelled their appointment with notification . RESULTS The non-attendance rates in the text messaging group ( odds ratio [ OR ] = 0.62 , 95 % confidence interval [ CI ] = 0.41 to 0.93 , P = 0.020 ) and the telephone reminder group ( OR = 0.53 , 95 % CI = 0.35 to 0.81 ) , P = 0.003 ) were significantly lower than the control group . The absolute non-attendance rate for telephone reminders was lower by 2 % compared to the text messaging group . This difference was not found to be statistically significant ( P = 0.505 ) . CONCLUSION Text messaging was found to be as effective as telephone reminder in reducing non-attendance in patients who required long-term follow-up for their chronic illnesses in this study . It could be used as an alternative to conventional reminder systems Background : Hypertension frequently accompanies diabetes mellitus , worsening prognosis and complicating medical care for patients . Low medication adherence with multiple medications is a major factor in the inadequate achievement of blood pressure treatment goals . Widespread access to mobile phones offers a new opportunity to communicate with patients and enhance disease self-management . Methods : We recruited 50 high-risk urban patients with hypertension , who are using at least two prescription medications for hypertension , into an open-label trial using medication reminder software on a mobile phone . Medication adherence was assessed by review of pharmacy refill rates before , during , and after availability of the medication reminder software ( pre-activation , activation , and post-activation phase , respectively ) . Results : Forty-eight patients completed the study . All subjects were insured by Medicaid , 96 % were African-American , and the majority had diabetes mellitus . The proportion of days covered for each study phase was as follows : Pre-activation phase = 0.54 , activation phase = 0.58 , and post-activation phase = 0.46 . A significant difference was found between the activation and post-activation phases ( p = .001 ) . The increase in measured adherence between the pre-activation and activation phases approached significance ( p = .057 ) . Forty-six patients completed the pre- and post-Morisky medication adherence survey . The median score rose from 2.0 at baseline to 3.0 at study completion ( p < .001 ) . Average blood pressure and level of control during study period improved significantly after initiation of the study and remained improved from baseline through the course of the study . The 48 subjects who completed the study reported a high level of satisfaction with the medication reminder application at the final study visit . Conclusions : A mobile-phone-based automated medication reminder system shows promise in improving medication adherence and blood pressure in high-cardiovascular-risk individuals Introduction Many studies have now demonstrated the efficacy of text messaging in positively changing behaviours . We aim ed to identify features and factors that explain the effectiveness of a successful text messaging program in terms of user engagement , perceived usefulness , behavior change and program delivery preferences . Methods Mixed methods qualitative design combining four data sources ; ( i ) analytic data extracted directly from the software system , ( ii ) participant survey , ( iii ) focus groups to identify barriers and enablers to implementation and mechanisms of effect and ( iv ) recruitment screening logs and text message responses to examine engagement . This evaluation was conducted within the TEXT ME trial — a parallel design , single-blind r and omized controlled trial ( RCT ) of 710 patients with coronary heart disease ( CHD ) . Qualitative data were interpreted using inductive thematic analysis . Results 307/352 ( 87 % response rate ) of recruited patients with CHD completed the program evaluation survey at six months and 25 participated in a focus group . Factors increasing engagement included ( i ) ability to save and share messages , ( ii ) having the support of providers and family , ( iii ) a feeling of support through participation in the program , ( iv ) the program being initiated close to the time of a cardiovascular event , ( v ) personalization of the messages , ( vi ) opportunity for initial face-to-face contact with a provider and ( vii ) that program and content was perceived to be from a credible source . Clear themes relating to program delivery were that diet and physical activity messages were most valued , four messages per week was ideal and most participants felt program duration should be provided for at least for six months or longer . Conclusions This study provides context and insight into the factors influencing consumer engagement with a text message program aim ed at improving health-related behavior . The study suggests program components that may enhance potential success but will require integration at the development stage to optimize up-scaling . Trial Registration Australia and New Zeal and Clinical Trials Registry , ACTRN12611000161921 Background Cardiac rehabilitation ( CR ) is a secondary prevention program that offers education and support to assist patients with coronary heart disease ( CHD ) make lifestyle changes . Despite the benefits of CR , attendance at centre-based sessions remains low . Mobile technology ( mHealth ) has potential to reach more patients by delivering CR directly to mobile phones , thus providing an alternative to centre-based CR . The aim of this trial is to evaluate if a mHealth comprehensive CR program can improve adherence to healthy lifestyle behaviours ( for example , physically active , fruit and vegetable intake , not smoking , low alcohol consumption ) over and above usual CR services in New Zeal and adults diagnosed with CHD . Methods / design A two-arm , parallel , r and omised controlled trial will be conducted at two Auckl and hospitals in New Zeal and . One hundred twenty participants will be r and omised to receive a 24-week evidence - and theory-based personalised text message program and access to a supporting website in addition to usual CR care or usual CR care alone ( control ) . The primary outcome is the proportion of participants adhering to healthy behaviours at 6 months , measured using a composite health behaviour score . Secondary outcomes include overall cardiovascular disease risk , body composition , illness perceptions , self-efficacy , hospital anxiety/depression and medication adherence . Discussion This study is one of the first to examine an mHealth-delivered comprehensive CR program . Strengths of the trial include quality research design and in-depth description of the intervention to aid replication . If effective , the trial has potential to augment st and ard CR practice s and to be used as a model for other disease prevention or self-management programs . Trial registryAustralian New Zeal and Clinical Trials Registry : Background There are well-documented treatment gaps in secondary prevention of coronary heart disease and no clear guidelines to assist early physical activity after acute coronary syndromes ( ACS ) . Smartphone technology may provide an innovative platform to close these gaps . This paper describes the study design of a r and omized controlled trial assessing whether a smartphone-based secondary prevention program can facilitate early physical activity and improve cardiovascular health in patients with ACS . Methods We have developed a multi-faceted , patient-centred smartphone-based secondary prevention program emphasizing early physical activity with a graduated walking program initiated on discharge from ACS admission . The program incorporates ; physical activity tracking through the smartphone ’s accelerometer with interactive feedback and goal setting ; a dynamic dashboard to review and optimize cardiovascular risk factors ; educational messages delivered twice weekly ; a photographic food diary ; pharmacotherapy review ; and support through a short message service . The primary endpoint of the trial is change in exercise capacity , as measured by the change in six-minute walk test distance at 8-weeks when compared to baseline . Secondary endpoints include improvements in cardiovascular risk factor status , psychological well-being and quality of life , medication adherence , uptake of cardiac rehabilitation and re-hospitalizations . Discussion This r and omized controlled trial will use a smartphone-phone based secondary prevention program to emphasize early physical activity post-ACS . It will provide evidence regarding the feasibility and utility of this innovative platform in closing the treatment gaps in secondary prevention . Trial registration The trial was retrospectively registered in the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) on April 4 , 2016 . The registration number is ACTRN12616000426482 Background Mobile technology has the potential to deliver behavior change interventions ( mHealth ) to reduce coronary heart disease ( CHD ) at modest cost . Previous studies have focused on single behaviors ; however , cardiac rehabilitation ( CR ) , a component of CHD self-management , needs to address multiple risk factors . Objective The aim was to investigate the effectiveness of a mHealth-delivered comprehensive CR program ( Text4Heart ) to improve adherence to recommended lifestyle behaviors ( smoking cessation , physical activity , healthy diet , and nonharmful alcohol use ) in addition to usual care ( traditional CR ) . Methods A 2-arm , parallel , r and omized controlled trial was conducted in New Zeal and adults diagnosed with CHD . Participants were recruited in-hospital and were encouraged to attend center-based CR ( usual care control ) . In addition , the intervention group received a personalized 24-week mHealth program , framed in social cognitive theory , sent by fully automated daily short message service ( SMS ) text messages and a supporting website . The primary outcome was adherence to healthy lifestyle behaviors measured using a self-reported composite health behavior score ( ≥3 ) at 3 and 6 months . Secondary outcomes included clinical outcomes , medication adherence score , self-efficacy , illness perceptions , and anxiety and /or depression at 6 months . Baseline and 6-month follow-up assessment s ( unblinded ) were conducted in person . Results Eligible patients ( N=123 ) recruited from 2 large metropolitan hospitals were r and omized to the intervention ( n=61 ) or the control ( n=62 ) group . Participants were predominantly male ( 100/123 , 81.3 % ) , New Zeal and European ( 73/123 , 59.3 % ) , with a mean age of 59.5 ( SD 11.1 ) years . A significant treatment effect in favor of the intervention was observed for the primary outcome at 3 months ( AOR 2.55 , 95 % CI 1.12 - 5.84 ; P=.03 ) , but not at 6 months ( AOR 1.93 , 95 % CI 0.83 - 4.53 ; P=.13 ) . The intervention group reported significantly greater medication adherence score ( mean difference : 0.58 , 95 % CI 0.19 - 0.97 ; P=.004 ) . The majority of intervention participants reported reading all their text messages ( 52/61 , 85 % ) . The number of visits to the website per person ranged from zero to 100 ( median 3 ) over the 6-month intervention period . Conclusions A mHealth CR intervention plus usual care showed a positive effect on adherence to multiple lifestyle behavior changes at 3 months in New Zeal and adults with CHD compared to usual care alone . The effect was not sustained to the end of the 6-month intervention . A larger study is needed to determine the size of the effect in the longer term and whether the change in behavior reduces adverse cardiovascular events . Trial Registration ACTRN 12613000901707 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=364758&is Review = true ( Archived by WebCite at http://www.webcitation.org/6c4qhcHKt Background Cardiac telerehabilitation has been introduced as an adjunct or alternative to conventional center-based cardiac rehabilitation to increase its long-term effectiveness . However , before large-scale implementation and reimbursement in current health care systems is possible , well- design ed studies on the effectiveness of this new additional treatment strategy are needed . Objective The aim of this trial was to assess the medium-term effectiveness of an Internet-based , comprehensive , and patient-tailored telerehabilitation program with short message service ( SMS ) texting support for cardiac patients . Methods This multicenter r and omized controlled trial consisted of 140 cardiac rehabilitation patients r and omized ( 1:1 ) to a 24-week telerehabilitation program in combination with conventional cardiac rehabilitation ( intervention group ; n=70 ) or to conventional cardiac rehabilitation alone ( control group ; n=70 ) . In the telerehabilitation program , initiated 6 weeks after the start of ambulatory rehabilitation , patients were stimulated to increase physical activity levels . Based on registered activity data , they received semiautomatic telecoaching via email and SMS text message encouraging them to gradually achieve predefined exercise training goals . Patient-specific dietary and /or smoking cessation advice was also provided as part of the telecoaching . The primary endpoint was peak aerobic capacity ( VO2 peak ) . Secondary endpoints included accelerometer-recorded daily step counts , self-assessed physical activities by International Physical Activity Question naire ( IPAQ ) , and health-related quality of life ( HRQL ) assessed by the HeartQol question naire at baseline and at 6 and 24 weeks . Results Mean VO2 peak increased significantly in intervention group patients ( n=69 ) from baseline ( mean 22.46 , SD 0.78 mL/[min*kg ] ) to 24 weeks ( mean 24.46 , SD 1.00 mL/[min*kg ] , P<.01 ) versus control group patients ( n=70 ) , who did not change significantly ( baseline : mean 22.72 , SD 0.74 mL/[min*kg ] ; 24 weeks : mean 22.15 , SD 0.77 mL/[min*kg ] , P=.09 ) . Between-group analysis of aerobic capacity confirmed a significant difference between the intervention group and control group in favor of the intervention group ( P<.001 ) . At 24 weeks , self-reported physical activity improved more in the intervention group compared to the control group ( P=.01 ) as did the global HRQL score ( P=.01 ) . Conclusions This study showed that an additional 6-month patient-specific , comprehensive telerehabilitation program can lead to a bigger improvement in both physical fitness ( VO2 peak ) and associated HRQL compared to center-based cardiac rehabilitation alone . These results are supportive in view of possible future implementation in st and ard cardiac care IMPORTANCE Cardiovascular disease prevention , including lifestyle modification , is important but underutilized . Mobile health strategies could address this gap but lack evidence of therapeutic benefit . OBJECTIVE To examine the effect of a lifestyle-focused semipersonalized support program delivered by mobile phone text message on cardiovascular risk factors . DESIGN AND SETTING The Tobacco , Exercise and Diet Messages ( TEXT ME ) trial was a parallel-group , single-blind , r and omized clinical trial that recruited 710 patients ( mean age , 58 [ SD , 9.2 ] years ; 82 % men ; 53 % current smokers ) with proven coronary heart disease ( prior myocardial infa rct ion or proven angiographically ) between September 2011 and November 2013 from a large tertiary hospital in Sydney , Australia . INTERVENTIONS Patients in the intervention group ( n = 352 ) received 4 text messages per week for 6 months in addition to usual care . Text messages provided advice , motivational reminders , and support to change lifestyle behaviors . Patients in the control group ( n=358 ) received usual care . Messages for each participant were selected from a bank of messages according to baseline characteristics ( eg , smoking ) and delivered via an automated computerized message management system . The program was not interactive . MAIN OUTCOMES AND MEASURES The primary end point was low-density lipoprotein cholesterol ( LDL-C ) level at 6 months . Secondary end points included systolic blood pressure , body mass index ( BMI ) , physical activity , and smoking status . RESULTS At 6 months , levels of LDL-C were significantly lower in intervention participants , with concurrent reductions in systolic blood pressure and BMI , significant increases in physical activity , and a significant reduction in smoking . The majority reported the text messages to be useful ( 91 % ) , easy to underst and ( 97 % ) , and appropriate in frequency ( 86 % ) . [ table : see text ] . CONCLUSIONS AND RELEVANCE Among patients with coronary heart disease , the use of a lifestyle-focused text messaging service compared with usual care result ed in a modest improvement in LDL-C level and greater improvement in other cardiovascular disease risk factors . The duration of these effects and hence whether they result in improved clinical outcomes remain to be determined . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12611000161921 BACKGROUND The medical priority dispatch system ( MPDS ® ) assists lay rescuers in protocol -driven telephone-assisted cardiopulmonary resuscitation ( CPR ) . OBJECTIVE Our aim was to clarify which CPR instruction leads to sufficient compression depth . METHODS This was an investigator-blinded , r and omized , parallel group , simulation study to investigate 10 min of chest compressions after the instruction " push down firmly 5 cm " vs. " push as hard as you can . " Primary outcome was defined as compression depth . Secondary outcomes were participants exertion measured by Borg scale , provider 's systolic and diastolic blood pressure , and quality values measured by the skill-reporting program of the Resusci ( ® ) Anne Simulator manikin . For the analysis of the primary outcome , we used a linear r and om intercept model to allow for the repeated measurements with the intervention as a covariate . RESULTS Thirteen participants were allocated to control and intervention . One participant ( intervention ) dropped out after min 7 because of exhaustion . Primary outcome showed a mean compression depth of 44.1 mm , with an inter-individual st and ard deviation ( SDb ) of 13.0 mm and an intra-individual st and ard deviation ( SDw ) of 6.7 mm for the control group vs. 46.1 mm and a SDb of 9.0 mm and SDw of 10.3 mm for the intervention group ( difference : 1.9 ; 95 % confidence interval -6.9 to 10.8 ; p = 0.66 ) . Secondary outcomes showed no difference for exhaustion and CPR- quality values . CONCLUSIONS There is no difference in compression depth , quality of CPR , or physical strain on lay rescuers using the initial instruction " push as hard as you can " vs. the st and ard MPDS ( ® ) instruction " push down firmly 5 cm . BACKGROUND Although most cardiovascular disease occurs in low-income and middle-income countries , little is known about the use of effective secondary prevention medications in these communities . We aim ed to assess use of proven effective secondary preventive drugs ( antiplatelet drugs , β blockers , angiotensin-converting-enzyme [ ACE ] inhibitors or angiotensin-receptor blockers [ ARBs ] , and statins ) in individuals with a history of coronary heart disease or stroke . METHODS In the Prospect i ve Urban Rural Epidemiological ( PURE ) study , we recruited individuals aged 35 - 70 years from rural and urban communities in countries at various stages of economic development . We assessed rates of previous cardiovascular disease ( coronary heart disease or stroke ) and use of proven effective  secondary preventive drugs  and blood-pressure-lowering drugs with st and ardised question naires , which were completed by telephone interviews , household visits , or on patient 's presentation to clinics . We report estimates of drug use at national , community , and individual levels . FINDINGS We enrolled 153,996 adults from 628 urban and rural communities in countries with incomes classified as high ( three countries ) , upper-middle ( seven ) , lower-middle ( three ) , or low ( four ) between January , 2003 , and December , 2009 . 5650 participants had a self-reported coronary heart disease event ( median 5·0 years previously [ IQR 2·0 - 10·0 ] ) and 2292 had stroke ( 4·0 years previously [ 2·0 - 8·0 ] ) . Overall , few individuals with cardiovascular disease took antiplatelet drugs  ( 25·3 % ) , β blockers ( 17·4 % ) , ACE inhibitors or ARBs ( 19·5 % ) , or statins ( 14·6 % ) . Use was highest in high-income countries ( antiplatelet drugs 62·0 % , β blockers 40·0 % , ACE inhibitors or ARBs 49·8 % , and statins 66·5 % ) , lowest in low-income countries ( 8·8 % , 9·7 % , 5·2 % , and 3·3 % , respectively ) , and decreased in line with reduction of country economic status ( p(trend)<0·0001 for every drug type ) . Fewest patients received no drugs in high-income countries ( 11·2 % ) , compared with 45·1 % in upper middle-income countries , 69·3 % in lower middle-income countries , and 80·2 % in low-income countries . Drug use was higher in urban than rural areas ( antiplatelet drugs 28·7 % urban vs 21·3 % rural , β blockers 23·5%vs 15·6 % , ACE inhibitors or ARBs 22·8%vs 15·5 % , and statins 19·9%vs 11·6 % ; all p<0·0001 ) , with greatest variation in poorest countries ( p(interaction)<0·0001 for urban vs rural differences by country economic status ) . Country-level factors ( eg , economic status ) affected rates of drug use more than did individual-level factors ( eg , age , sex , education , smoking status , body-mass index , and hypertension and diabetes statuses ) . INTERPRETATION Because use of secondary prevention medications is low worldwide-especially in low-income countries and rural areas - systematic approaches are needed to improve the long-term use of basic , inexpensive , and effective drugs . FUNDING Full funding sources listed at end of paper ( see Acknowledgments ) Background : Medication non-adherence leads to a vast range of negative outcomes in patients with coronary artery disease . An automated web-based system managing short message service ( SMS ) reminders is a telemedicine approach to optimise adherence among patients who frequently forget to take their medications or miss the timing . Aim : This paper sought to investigate the effect of automated SMS-based reminders on medication adherence in patients after hospital discharge following acute coronary syndrome ( ACS ) . Methods : An interventional study was conducted at a tertiary teaching hospital in Malaysia . A total of 62 patients with ACS were equally r and omised to receive either automated SMS reminders before every intake of cardiac medications or only usual care within eight weeks after discharge . The primary outcome was adherence to cardiac medications . Secondary outcomes were the heart functional status , and ACS-related hospital readmission and death rates . Results : There was a higher medication adherence level in the intervention group rather than the usual care group , ( χ2 (2)=18.614 , p<0.001 ) . The risk of being low adherent among the control group was 4.09 times greater than the intervention group ( relative risk = 4.09 , 95 % confidence interval ( CI ) 1.82–9.18 ) . A meaningful difference was found in heart functional status between the two study groups with better results among patients who received SMS reminders , ( χ2 ( 1 ) = 16.957 , p<0.001 ) . Conclusion : An automated SMS-based reminder system can potentially enhance medication adherence in ACS patients during the early post-discharge period Background Mobile phone text message interventions are used to support behaviour change including physical activity , but we have less insight into how these interventions work and what factors predict response . Aims To study the effect of TEXT ME ( Tobacco EXercise and dieT Messages ) text message intervention on physical activity domains , consistency of effects across sub-groups and its additive value in patients that received traditional cardiac rehabilitation programme . Methods This is a secondary analysis of the TEXT ME , a r and omized clinical trial of lifestyle-focused text message intervention compared with usual care in patients with coronary heart disease . A quarter of the messages were design ed specifically to encourage physical activity . Sedentary time and physical activity were assessed using the Global Physical Activity Question naire . Results At baseline , 85 % of the 710 participants reported low physical activity levels . At six months , compared with controls , the intervention arm reported higher recreational physical activity ( 471 vs. 307 metabolic equivalent-min/week , p = 0.001 ) and travel physical activity ( 230 vs. 128 MET-min/week , p = 0.002 ) , similar work-related physical activity and lower sedentary times ( 494 vs. 587 min , p < 0.001 ) . Male gender , high baseline physical activity , cardiac rehabilitation participation and text message intervention predicted physically active status at six months . Subjects that received both cardiac rehabilitation and text messaging intervention were more likely to achieve target physical activity levels compared with cardiac rehabilitation alone ( odds ratio 7.07 vs. 1.80 , p < 0.001 ) . Conclusions The TEXT ME intervention improved recreational and travel physical activity , reduced sedentary times but had no effects on work-related physical activity . It had incremental benefits at achieving target physical activity levels even in patients participating in the traditional cardiac rehabilitation programme BACKGROUND Patients undergoing cardiovascular procedures remain at increased risk for myocardial infa rct ion , stroke , and cardiovascular death . Risk factor control in this patient population remains suboptimal and would likely benefit from strategies targeting education , lifestyle , and healthy behaviors . DESIGN The IMPACT trial is a 400-subject prospect i ve r and omized trial design ed to compare different cardiovascular prevention strategies in subjects following a cardiovascular intervention . The trial began enrollment in the Spring of 2012 and is r and omizing subjects in a 1:1:1 manner to usual care , a one-time cardiovascular prevention consult , or a one-time cardiovascular prevention consult plus behavioral intervention program ( telephone-based motivational interviewing and tailored text messages ) over a 6-month period . The primary end point is non-high-density lipoprotein cholesterol . Secondary end points include other plasma lipid values , metabolic risk , smoking cessation , physical activity , dietary intake , medication use and adherence , and quality of life . CONCLUSIONS The IMPACT trial provides data on different management strategies for risk factor optimization in subjects following cardiovascular procedures . The results will provide a platform for the continued development of novel multidisciplinary interventions in this high-risk population Background : Self-care management has recently been suggested as an effective approach for secondary prevention of hypertension . This study was conducted to examine whether self-care behaviors could modulate blood pressure levels and also comparing the different training methods of self-care on patients ' adherence and controlling hypertension . Material s and Methods : This study was a prospect i ve r and omized controlled clinical trial , conducted on 180 hypertensive patients referring to four centers in Isfahan , Iran , between July and December 2013 . Block r and omization method were applied to divide eligible subjects into four equal groups , including group A in which the patients and their family were educated by cardiology resident about self-care behaviors through eight sessions , group B and group C were obtained self-care education through four pamphlets or eight short message services ( SMS ) , respectively and group D were obtained only usual care of hypertension without any training about self-care management . Results : Increasing vegetable intake and frequency of subject who took antihypertensive medication regularly and the reduction in the frequency of subjects who consumed high salt were significantly more in group A than the others ( P = 0.001 , P < 0.001 and P < 0.001 , respectively ) . The systolic and diastolic blood pressure had significantly more reduction in the group A than the other groups ( −8.18 ± 18.3 and − 3.89 ± 4.1 ; P < 0.001 , respectively ) . Conclusions : The self-care management education integration into the usual care along with using SMS and other educational material s may improve the efficient and effective adherence strategies AIMS The rapidly increasing prevalence of chronic diseases is an important challenge to healthcare systems worldwide . To improve the quality and efficiency of chronic disease care , we investigated the effectiveness and applicability of the Ubiquitous Chronic Disease Care ( UCDC ) system using cellular phones and the internet for overweight patients with both Type 2 diabetes and hypertension . METHODS We conducted a r and omized , controlled clinical trial over 3 months that included 123 patients at a university hospital and a community public health centre . RESULTS After 12 weeks , there were significant improvements in HbA(1c ) in the intervention group ( 7.6 + /- 0.9 % to 7.1 + /- 0.8 % , P < 0.001 ) compared with the control group ( 7.4 + /- 0.9 % to 7.6 + /- 1.0 % , P = 0.03 ) . Furthermore , we observed a significant reduction in systolic and diastolic blood pressure , as well as improvements in total cholesterol , low-density lipoprotein-cholesterol and triglyceride levels in the intervention group . Furthermore , there was a significant increase in adiponectin levels in the intervention group compared with the control group , although high-sensitivity C-reactive protein and interleukin-6 levels did not change in either group . CONCLUSIONS The novel UCDC system presented in this paper improved multiple metabolic parameters simultaneously in overweight patients with both Type 2 diabetes and hypertension Background : Cardiac self-efficacy is an essential factor in persistence of healthy behaviors in patients with coronary artery disease ( CAD ) . Today , telenursing methods have numerous applications in health care . Therefore , this study aim ed to determine the effect of a text message and telephone follow-up program on cardiac self-efficacy of patients with CAD . Material s and Methods : This was a r and omized controlled trial on 70 patients with CAD who were hospitalized in Shahid Chamran Hospital ( Isfahan , Iran ) . The participants were r and omly assigned to the experimental and control groups . Collection of data on cardiac self-efficacy was performed before , 3 months after , and 4 months after the beginning of the intervention using Cardiac Self-Efficacy Scale design ed by Sullivan et al. During the 3 months of intervention , six messages were sent to the subjects each week and calls were made twice a week in the first month and once a week during the second and third months . The statistical analysis of data was performed using independent t-test , Chi-square , Mann-Whitney U test , and repeated measures analysis of variance ( ANOVA ) . Results : Before the intervention , there was no significant difference between the mean scores of cardiac self-efficacy of the two groups . However , 3 months and 4 months after the beginning of the intervention , the mean score of cardiac self-efficacy in the experimental group was significantly higher than in the control group ( P < 0.001 ) . Conclusions : The text message and telephone follow-up program is effective in promoting the cardiac self-efficacy of patients with CAD Rationale Stroke is the second-leading cause of death in low- and middle-income countries , but use of evidence -based therapies for stroke prevention in such countries , especially those in Africa , is extremely poor . This study is design ed to enhance the implementation and sustainability of secondary stroke-preventive services following hospital discharge . Aim /Hypothesis The primary study aim is to test whether a Chronic Care Model-based initiative entitled the Tailored Hospital-based Risk reduction to Impede Vascular Events after Stroke ( THRIVES ) significantly improves blood pressure control after stroke . Design This prospect i ve triple-blind r and omized controlled trial will include a cohort of 400 patients with a recent stroke discharged from four medical care facilities in Nigeria . The culturally sensitive , system-appropriate intervention comprises patient report cards , phone text messaging , an educational video , and coordination of posthospitalization care . Study Outcomes The primary outcome is improvement of blood pressure control . Secondary endpoints include control of other stroke risk factors , medication adherence , functional status , and quality of life . We will also perform a cost analysis of THRIVES from the viewpoint of government policy-makers . Discussion We anticipate that a successful intervention will serve as a scalable model of effective postdischarge chronic blood pressure management for stroke in sub-Saharan Africa and possibly for other symptomatic cardiovascular disease entities in the region Background Mobile health ( mHealth ) interventions may improve heart failure ( HF ) self-care , but st and ard models do not address informal caregivers ’ needs for information about the patient ’s status or how the caregiver can help . Objective We evaluated mHealth support for caregivers of HF patients over and above the impact of a st and ard mHealth approach . Methods We identified 331 HF patients from Department of Veterans Affairs outpatient clinics . All patients identified a “ CarePartner ” outside their household . Patients r and omized to “ st and ard mHealth ” ( n=165 ) received 12 months of weekly interactive voice response ( IVR ) calls including questions about their health and self-management . Based on patients ’ responses , they received tailored self-management advice , and their clinical team received structured fax alerts regarding serious health concerns . Patients r and omized to “ mHealth+CP ” ( n=166 ) received an identical intervention , but with automated emails sent to their CarePartner after each IVR call , including feedback about the patient ’s status and suggestions for how the CarePartner could support disease care . Self-care and symptoms were measured via 6- and 12-month telephone surveys with a research associate . Self-care and symptom data also were collected through the weekly IVR assessment s. Results Participants were on average 67.8 years of age , 99 % were male ( 329/331 ) , 77 % where white ( 255/331 ) , and 59 % were married ( 195/331 ) . During 15,709 call-weeks of attempted IVR assessment s , patients completed 90 % of their calls with no difference in completion rates between arms . At both endpoints , composite quality of life scores were similar across arms . However , more mHealth+CP patients reported taking medications as prescribed at 6 months ( 8.8 % more , 95 % CI 1.2 - 16.5 , P=.02 ) and 12 months ( 13.8 % more , CI 3.7 - 23.8 , P<.01 ) , and 10.2 % more mHealth+CP patients reported talking with their CarePartner at least twice per week at the 6-month follow-up ( P=.048 ) . mHealth+CP patients were less likely to report negative emotions during those interactions at both endpoints ( both P<.05 ) , were consistently more likely to report taking medications as prescribed during weekly IVR assessment s , and also were less likely to report breathing problems or weight gains ( all P<.05 ) . Among patients with more depressive symptoms at enrollment , those r and omized to mHealth+CP were more likely than st and ard mHealth patients to report excellent or very good general health during weekly IVR calls . Conclusions Compared to a relatively intensive model of IVR monitoring , self-management assistance , and clinician alerts , a model including automated feedback to an informal caregiver outside the household improved HF patients ’ medication adherence and caregiver communication . mHealth+CP may also decrease patients ’ risk of HF exacerbations related to shortness of breath and sudden weight gains .  mHealth+CP may improve quality of life among patients with greater depressive symptoms . Weekly health and self-care monitoring via mHealth tools may identify intervention effects in mHealth trials that go undetected using typical , infrequent retrospective surveys . Trial Registration Clinical Trials.gov NCT00555360 ; https:// clinical trials.gov/ct2/show/NCT00555360 ( Archived by WebCite at http://www.webcitation.org/6Z4Tsk78B ) Antihypertensive drug adherence ( ADA ) is a mainstay in blood pressure control . Education through mobile phone short message system ( SMS ) text messaging could improve ADA . The authors conducted a r and omized study involving 314 patients with hypertension with < 6 months of antihypertensive treatment from the Preventive Health Program of 12 different primary care centers in Santiago , Chile . Patients were r and omly assigned to receive or not receive SMS related to ADA and healthy lifestyle .  Adherence was assessed by the self-reported four-item scale Morisky-Green-Levine question naire at baseline and after 6 months of follow-up , with four of four positive questions classified as good adherence . Group comparison for adherence was performed by means of a logistic regression model , adjusting by baseline adherence , age older than 60 years , and sex . A total of 163 patients were r and omized to receive and 151 to not receive SMS . After 6 months of follow-up , ADA in the non-SMS group decreased from 59.3 % to 51.4 % ( P=.1 ) . By contrast , adherence increased from 49 % to 62.3 % ( P=.01 ) in the SMS group . Text messaging intervention  improved ADA ( risk ratio , 1.3 ; 95 % confidence interval , 1.0 - 1.6 [ P<.05 ] ) . At 6-month follow-up , text messaging result ed in an increase in reporting ADA in this hypertensive Latino population . This approach could become an effective tool to overcome poor medication adherence in the community An Internet-based store- and -retrieval telemedicine system to communicate between patients and their healthcare provider was tested . The system requires no specialized equipment , is Web-based , and allows frequent surveillance of the health status of the patients with heart failure ( HF ) . Thirty six patients were recruited to evaluate a Web-based telemedicine system for reducing care encounters . Eighteen patients were r and omized to the telemedicine arm ( group T ) , and 18 were given usual clinical care ( group C ) in our HF center . Patients in group T reported three times weekly via a secure Internet site for telemedicine intervention . We studied patients with HF with New York Heart Association ( NYHA ) class 2 to 4 with hospitalization within past 6 months . Mean age was 56.1 + /- 12.6 years ( 66.7 % male ; 66.7 % Caucasian , 27.8 % African American , and 5.6 % Hispanic ) .  Mean ejection fraction ( EF ) was 23.9 % + /- 17.6 % in group T and 26.6 % + /- 16.4 % in group C. Over an 8-month period , unscheduled ( group T-3 ; group C-5 ) , and scheduled clinic visits ( group T-11 , group C-7 ) were similar ( p = NS ) ; one group T patient was transplanted , one group C patient died . Total hospital days were lower with group T ( 44 days ) compared to group C ( 133 days ) , p < 0.05 . An Internet-based telemedicine system was able to closely monitor patients with HF . Surveillance through Internet-based telemedicine result ed in less hospitalization compared to control patients . This system may be helpful in reducing the cost of HF patient care Background An increase in physical activity for secondary prevention of cardiovascular disease and cardiac rehabilitation has multiple therapeutic benefits , including decreased mortality . Internet- and mobile-based interventions for physical activity have shown promising results in helping users increase or maintain their level of physical activity in general and specifically in secondary prevention of cardiovascular diseases and cardiac rehabilitation . One component related to the efficacy of these interventions is tailoring of the content to the individual . Objective Our trial assessed the effect of a longitudinally tailored Internet- and mobile-based intervention for physical activity as an extension of a face-to-face cardiac rehabilitation stay . We hypothesized that users of the tailored intervention would maintain their physical activity level better than users of the nontailored version . Methods The study population included adult participants of a cardiac rehabilitation program in Norway with home Internet access and a mobile phone . The participants were r and omized in monthly clusters to a tailored or nontailored ( control ) intervention group . All participants had access to a website with information regarding cardiac rehabilitation , an online discussion forum , and an online activity calendar . Those using the tailored intervention received tailored content based on models of health behavior via the website and mobile fully automated text messages . The main outcome was self-reported level of physical activity , which was obtained using an online international physical activity question naire at baseline , at discharge , and at 1 month and 3 months after discharge from the cardiac rehabilitation program . Results Included in the study were 69 participants . One month after discharge , the tailored intervention group ( n=10 ) had a higher median level of overall physical activity ( median 2737.5 , IQR 4200.2 ) than the control group ( n=14 , median 1650.0 , IQR 2443.5 ) , but the difference was not significant ( Kolmogorov-Smirnov Z=0.823 , P=.38 , r=.17 ) . At 3 months after discharge , the tailored intervention group ( n=7 ) had a significantly higher median level of overall physical activity ( median 5613.0 , IQR 2828.0 ) than the control group ( n=12 , median 1356.0 , IQR 2937.0 ; Kolmogorov-Smirnov Z=1.397 , P=.02 , r=.33 ) . The median adherence was 45.0 ( 95 % CI 0.0 - 169.8 ) days for the tailored group and 111.0 ( 95 % CI 45.1 - 176.9 ) days for the control group ; however , the difference was not significant ( P=.39 ) . There were no statistically significant differences between the 2 groups in stage of change , self-efficacy , social support , perceived tailoring , anxiety , or depression . Conclusions Because of the small sample size and the high attrition rate at the follow-up visits , we can not make conclusions regarding the efficacy of our approach , but the results indicate that the tailored version of the intervention may have contributed to the long-term higher physical activity maintained after cardiac rehabilitation by participants receiving the tailored intervention compared with those receiving the nontailored intervention . Trial Registration Clinical Trials.gov : NCT01223170 ; http:// clinical trials.gov/show/NCT01223170 ( Archived by WebCite at http://www.webcitation.org/6Nch4ldcL ) OBJECTIVE Pharmacologic treatment for secondary prevention of coronary heart disease ( CHD ) is critical to prevent adverse clinical outcomes . In a r and omized controlled trial , we compared antiplatelet and statin adherence among patients with CHD who received : ( 1 ) text messages ( TM ) for medication reminders and education , ( 2 ) educational TM only , or ( 3 ) No TM .  METHODS A mobile health intervention delivered customized TM for 30 days . We assessed and analyzed medication adherence with electronic monitoring devices [ Medication Event Monitoring System ( MEMS ) ] by one-way ANOVA and Welch tests , two-way TM response rates by t-tests , and self-reported adherence ( Morisky Medication Adherence Scale ) by Repeated Measures ANOVA . RESULTS Among 90 patients ( 76 % male , mean age 59.2 years ) , MEMS revealed patients who received TM for antiplatelets had a higher percentage of correct doses taken ( p=0.02 ) , percentage number of doses taken ( p=0.01 ) , and percentage of prescribed doses taken on schedule ( p=0.01 ) .  TM response rates were higher for antiplatelets than statins ( p=0.005 ) . Self-reported adherence revealed no significant differences among groups . CONCLUSION TM increased adherence to antiplatelet therapy demonstrated by MEMS and TM responses . PRACTICE IMPLICATION S Feasibility and high satisfaction were established . Mobile health interventions show promise in promoting medication adherence Background About one third of patients prescribed blood pressure or lipid-lowering drugs for the prevention of coronary heart disease and stroke do not take their medication as prescribed . We conducted a r and omized trial to evaluate text messaging as a means of improving adherence to cardiovascular disease preventive treatment . Methods 303 patients taking blood pressure and /or lipid-lowering medications were r and omly assigned to being sent text messages ( Text group , 151 ) or not being sent them ( No text group , 152 ) . Texts were sent daily for 2 weeks , alternate days for 2 weeks and weekly thereafter for 22 weeks ( 6 months overall ) , using an automated computer programme . Patients were asked to respond on whether they had taken their medication , whether the text reminded them to do so if they had forgotten , and if they had not taken their medication to determine if there was a reason for not doing so . At 6 months , use of medication was assessed . Results Two patients were lost to follow-up , providing data on 301 for analysis . In the No text group 38/151 ( 25 % ) took less than 80 % of the prescribed regimen ( ie . stopped medication completely or took it on fewer than 22 of the last 28 days of follow-up ) compared to 14/150 patients ( 9 % ) in the Text group – an improvement in adherence affecting 16 per 100 patients ( 95 % CI 7 to 24 ) , p<0.001 . The texts reminded 98/151 patients ( 65 % ) to take medication on at least one occasion and lead to 20/151 ( 13 % ) who stopped taking medication because of concern over efficacy or side-effects , resuming treatment . Conclusions In patients taking blood pressure or lipid-lowering treatment for the prevention of cardiovascular disease , text messaging improved medication adherence compared with no text messaging . Trial Registration Controlled-Trials.com IS RCT BACKGROUND : Mobile technologies ( mHealth ) have recently been used to deliver behavior change interventions ; however , few have investigated the application of mHealth for treatment of ischemic heart disease ( IHD ) . The Heart Exercise And Remote Technologies trial examined the effectiveness of an mHealth intervention to increase exercise behavior in adults with IHD . As a part of this trial , a process evaluation was conducted . METHODS : One hundred seventy-one adults with IHD were r and omized to receive a 6-month mHealth intervention ( n = 85 ) plus usual care or usual care alone ( n = 86 ) . The intervention delivered a theory-based , automated package of exercise prescription and behavior change text messages and a supporting Web site . Three sources of data were triangulated to assess intervention participant perceptions : ( 1 ) Web site usage statistics ; ( 2 ) feedback surveys ; and ( 3 ) semistructured exit interviews . Descriptive information from survey and Web data were merged with qualitative data and analyzed using a semantic thematic approach . RESULTS : At 24 weeks , all intervention participants provided Web usage statistics , 75 completed the feedback survey , and 17 were interviewed . Participants reported reading the text messages ( 70/75 ; 93 % ) and liked the content ( 55/75 ; 73 % ) . The program motivated participants to exercise . Several suggestions to improve the program included further tailoring of the content ( 7/75 ; 7 % ) and increased personal contact ( 10/75 ; 13 % ) . CONCLUSIONS : Adults with IHD were able to use an mHealth program and reported that text messaging is a good way to deliver exercise information . While mHealth is design ed to be automated , programs might be improved if content and delivery were tailored to individual needs Background Hypertension ( HTN ) is a major public health concern in the United States , with almost 78 million Americans age 20 years and over suffering from the condition . Moreover , HTN is a key risk factor for health disease and stroke . African Americans disproportionately shoulder the burdens of HTN , with greater prevalence , disease severity , earlier onset , and more HTN-related complications than age-matched whites . Medication adherence for the treatment of HTN is poor , with estimates indicating that only about half of hypertensive patients are adherent to prescribed medication regimens . Although no single intervention for improving medication adherence has emerged as superior to others , text message medication reminders have the potential to help improve medication adherence in African Americans with uncontrolled HTN as mobile phone adoption is very high in this population . Objective The purpose of this two-phased study was to develop ( Phase I ) and test in a r and omized controlled trial ( RCT ) ( Phase II ) a text message system , BPMED , to improve the quality of medication management through increasing medication adherence in African Americans with uncontrolled HTN . Methods In Phase I , we recruited 16 target end-users from a primary care clinic , to assist in the development of BPMED through participating in one of three focus groups . Focus groups sought to gain patient perspectives on HTN , medication adherence , mobile phone use , and the use of text messaging to support medication adherence . Potential intervention design s were presented to participants , and feedback on the design s was solicited . In Phase II , we conducted two pilot RCTs to determine the feasibility , acceptability , and preliminary efficacy of BPMED in primary care and emergency department setting s. Both pilot studies recruited approximately 60 participants , who were r and omized equally between usual care and the BPMED intervention . Results Although data collection is now complete , data analysis from the two pilot RCTs is still ongoing and results are expected in 2015 . Conclusions This study was design ed to determine preliminary feasibility and acceptability of our approach among African Americans with uncontrolled HTN in primary care and emergency department setting s. Results from these studies are of great interest as little work has been done to document the use of text message medication reminders to improve HTN-related outcomes , particularly within underserved urban minorities . Trial Registration Clinical trials.gov NCT01465217 ; https:// clinical trials.gov/ct2/show/NCT01465217 ( Archived by WebCite at http://www.webcitation.org/6V0tto0lZ ) PURPOSE : Efficient ways are needed to implement the secondary prevention ( SP ) of coronary heart disease . Because few studies have investigated Web-based SP programs , our aim was to determine the usefulness of a new Web-based telemonitoring system , connecting patients provided with self-measurement devices and care managers via mobile phone text messages , as a tool for SP . METHODS : A single-blind , r and omized controlled , clinical trial of 203 acute coronary syndrome ( ACS ) survivors , was conducted at a hospital in Madrid , Spain . All patients received lifestyle counseling and usual-care treatment . Patients in the telemonitoring group ( TMG ) sent , through mobile phones , weight , heart rate , and blood pressure ( BP ) weekly , and capillary plasma lipid profile and glucose monthly . A cardiologist accessed these data through a Web interface and sent recommendations via short message service . Main outcome measures were BP , body mass index ( BMI ) , smoking status , low-density lipoprotein-cholesterol ( LDL-c ) , and glycated hemoglobin A1c ( HbA1c ) . RESULTS : At 12-month followup , TMG patients were more likely ( RR = 1.4 ; 95 % CI = 1.1−1.7 ) to experience improvement in cardiovascular risk factors profile than control patients ( 69.6 % vs 50.5 % , P = .010 ) . More TMG patients achieved treatment goals for BP ( 62.1 % vs 42.9 % , P = .012 ) and HbA1c ( 86.4 % vs 54.2 % , P = .018 ) , with no differences in smoking cessation or LDL-c . Body mass index was significantly lower in TMG ( −0.77 kg/m2 vs + 0.29 kg/m2 , P = .005 ) . CONCLUSIONS : A telemonitoring program , via mobile phone messages , appears to be useful for improving the risk profile in ACS survivors and can be an effective tool for secondary prevention , especially for overweight patients We conducted a feasibility study of a telehealth intervention ( an electronic pill box ) and an m-health intervention ( an app on a smartphone ) for improving medication adherence in older adults with heart failure . A secondary aim was to compare patient acceptance of the devices . The participants were 60 adults with HF ( 65 % male ) . Their average age was 69 years and 83 % were Caucasian . Patients were r and omized using a 2 × 2 design to one of four groups : pillbox silent , pillbox reminding , smartphone silent , smartphone reminding . We examined adherence to 4 medications over 28 days . The overall adherence rate was 78 % ( SD 35 ) . People with the telehealth device adhered 80 % of the time and people with the smartphone adhered 76 % of the time . Those who received reminders adhered 79 % of the time , and those with passive medication reminder devices adhered 78 % of the time , i.e. reminding did not improve adherence . Patients preferred the m-health approach . Future interventions may need to address other contributors to poor adherence such as motivation Objective : Medication adherence is a complex behavior that is influenced by numerous factors . Applying self-efficacy theory , the primary aim of this r and omized controlled trial was to compare medication self-efficacy among patients with coronary heart disease who received : ( a ) text messages ( TMs ) for medication reminders and education , ( b ) TMs for education , or ( c ) no TMs .  The second aim was to identify the personal ( sociodemographic and clinical characteristics ) and psychosocial factors that were associated with and predicted medication adherence . Methods : Customized TMs were delivered over 30 days . Repeated measures analysis of variance was used to analyze medication self-efficacy . A multiple regression analysis was performed at baseline and follow-up to determine variables that were associated with and predicted self-reported medication adherence . Results : Among 90 subjects with mean age 59.2 years ( st and ard deviation ( SD ) 9.4 , range 35–83 ) , total scores for medication self-efficacy improved over 30 days ; however , there was no significant difference in this improvement as a function of the different treatment groups ( p=0.64 ) . Controlling for other variables in the model ( age , education , depression , and social support ) , less depression ( p=0.004 ) and higher social support ( p=0.02 ) positively predicted higher medication adherence in the final model . Conclusions : TM medication reminders and /or health education did not improve medication self-efficacy . Further theory testing of current and future models and interventions are required to underst and variables related to self-efficacy and medication adherence . Addressing psychosocial factors such as depression and social support should be a priority to improve medication adherence among patients with coronary heart disease
target: While the results of this systematic review are promising , there is insufficient evidence to draw conclusions on the effectiveness of text message-based interventions for adherence to medications for secondary prevention of CVD .
background: BACKGROUND Worldwide at least 100 million people are thought to have prevalent cardiovascular disease ( CVD ) .
  This population has a five times greater chance of suffering a recurrent cardiovascular event than people without known CVD .
  Secondary CVD prevention is defined as action aim ed to reduce the probability of recurrence of such events .
  Drug interventions have been shown to be cost-effective in reducing this risk and are recommended in international guidelines .
  However , adherence to recommended treatments remains sub-optimal .
  In order to influence non-adherence , there is a need to develop scalable and cost-effective behaviour-change interventions .
  OBJECTIVES To assess the effects of mobile phone text messaging in patients with established arterial occlusive events on adherence to treatment , fatal and non-fatal cardiovascular events , and adverse effects .