What is the clinical evidence from this study?

Study design: Observational. Population: Cardiovascular disease (n=11542). Intervention: HeartHealth program (text message support) vs. Usual care (no text messages). Primary outcome: Incidence rate of all-cause health care utilization events (composite of ED presentations and/or hospital admissions) (RR 0.91, 95% CI 0.83-0.99, p=0.033).

What does this research mean for the field?

A semipersonalized text message support program reduces the rate of all-cause health care utilization events compared to usual care in postdischarge cardiovascular patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 6, 2025JACC Advances1 citationsOpen Access

Implementation and Impact of Postdischarge Support of Cardiovascular Patients Using Text Messages The HeartHealth Program

BSBrodie SheahenThe University of Sydney SMSimone MarschnerPreventive Cardiology HMHaeri MinThe University of Sydney

Key Result

The HeartHealth text message support program reduced the rate of all-cause health care utilization events (RR 0.91) compared to usual care in postdischarge cardiovascular patients.

Study Design

Type

Observational (n=11,542)

Multicenter

Structured PICO

Does a text message support program reduce all-cause health care utilization events in cardiovascular patients postdischarge?

Population

11,542 patients ≥18 years old who attended cardiology clinics or were discharged from the cardiology unit at Westmead Hospital (Western Sydney, Australia) between April 2020 and April 2022, mean age 58.8, 60.7% male.

Intervention

HeartHealth program (regular semipersonalized text messages providing cardiovascular disease information, advice, and support over a 6-month period).

Comparator

Patients who did not enroll in the HeartHealth program.

Outcome

Incidence rate of all-cause health care utilization events in the 6 months postdischarge.composite

A 6-month text message support program significantly reduced all-cause health care utilization events in cardiovascular patients postdischarge, particularly in those over 65 years old.

Main Result

Effect estimate: RR 0.91 (95% CI 0.83-0.99)

Absolute Event Rate: 0.43% vs 0.52%

p-value: p=0.033

Limitations

Nonrandomized design with baseline discrepancies in comorbidity and demographic variables between cohorts
Health care service events were only collected from Western Sydney Local Health District hospitals
Conducted within a single local health district, potentially limiting generalizability
Lack of data on key social determinants of health such as income, employment status, and education levels
Retrospective nature of the study design limited data on lifestyle change

Abstract

BACKGROUND: The HeartHealth program is a text message support program for cardiovascular patients in Western Sydney, Australia. It comprised regular semipersonalized text messages providing cardiovascular disease information, advice, and support over a 6-month period. OBJECTIVES: This study aimed to examine the impact of the HeartHealth program on health care service utilization. METHODS: This is an observational study that compared hospitalization rates in patients who enrolled in the HeartHealth program to patients who did not. Patients ≥18 years old who attended cardiology clinics or were discharged from the cardiology unit at Westmead Hospital between April 2020 and April 2022 were invited to participate in HeartHealth. The primary outcome was the incidence rate of all-cause health care utilization events in the 6 months postdischarge. All analyses were adjusted for demographic and comorbidity variables. RESULTS: 11,542 patients were included in the analysis (intervention: 4,324, control: 7,218), with a mean age of 58.8 ± 17.0 years, and 60.7% (7,003/11,535) were male. HeartHealth participants had lower rates of health care service events compared to control participants (number of events per patient: 0.43 intervention vs 0.52 control; adjusted rate ratio RR: 0.91 95% CI: 0.83-0.99; P = 0.033). There was a greater reduction in health care utilization events in older (>65 years old) compared to younger patients (RR: 0.82; 95% CI: 0.72-0.93 vs RR: 0.98; 95% CI: 0.87-1.10, respectively; interaction P = 0.043). HeartHealth participants reported that the program improved diet, physical activity levels, and medication compliance. CONCLUSIONS: This analysis demonstrates the potential of text message-based postdischarge support for cardiovascular disease patients to decrease their need for health care service utilization for all medical causes.

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