Mobile Phone-Assisted Lifestyle Modifications to Reduce Mortality Due to Coronary Heart Disease – the results of a Randomized Controlled Clinical Trial from Pakistan (Preprint)

BACKGROUND Cardiovascular disease is prevalent in Pakistan and is a major cause of premature mortality. The unhealthy diet, cigarette smoking, pollution, sedentary lifestyle, and psychological factors such as depression and anxiety are among the major modifiable risk factors. The advancement of communication technology can bring behavioral changes in personalized health education and healthcare management. The study explores a mobile phone text messaging intervention program’s effectiveness in reducing mortality in patients with coronary artery disease. OBJECTIVE The study explores a mobile phone text messaging intervention program’s effectiveness in reducing mortality in patients with coronary artery disease and providing primary prevention for their immediate caregivers. METHODS A randomized controlled clinical trial was conducted in 3 cardiac-specific tertiary care hospitals in Karachi, Pakistan. The participants were patients having their first cardiac events and their nominated caregivers. Patients and their caregivers were randomized into two groups, intervention (IG) or usual care group with no-intervention (NIG). For the participants in the IG, daily health text messages were sent to their mobile phones 5 days per week. Patients in both groups were followed up at 6 monthly intervals. RESULTS Overall, there were 86 (3.2%) deaths during the study, 41 deaths in intervention and 45 deaths in non-intervention group. Caregivers were excluded from the analysis as there were no deaths among them. Kaplan–Meier survival analysis showed that the mean survival time in IG (534 days) and NIG (514 days) were not significantly different. Cox-regression analysis showed that old age, unemployment, history of diabetes, hypertension, and non-physical activity were independently associated with mortality in first-ever CAD patients. CONCLUSIONS The intervention of mobile phone text messaging to promote a healthy lifestyle was not effective in reducing the mortality among patients in Pakistan. Future interventions for patients with CAD with their first cardiac event living in Pakistan should specifically target the modifiable risk factors of unemployment, management of diabetes and hypertension, and non-physical activity to reduce the risk of premature mortality in this population. CLINICALTRIAL The clinical trial is registered at the Australia New Zealand Clinical Trial Registry (Reg. No: ACTRN12611000388910.)