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  • 1
    In: JAMA Network Open, American Medical Association (AMA), Vol. 4, No. 9 ( 2021-09-29), p. e2127573-
    Type of Medium: Online Resource
    ISSN: 2574-3805
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2021
    detail.hit.zdb_id: 2931249-8
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  • 2
    In: BMJ Open, BMJ, Vol. 7, No. 12 ( 2017-12), p. e018302-
    Abstract: Mobile health interventions have the potential to promote risk factor management and lifestyle modification, and are a particularly attractive approach for scaling across healthcare systems with limited resources. We are conducting two randomised trials to evaluate the efficacy of text message-based health messages in improving secondary coronary heart disease (CHD) prevention among patients with or without diabetes. Methods and analysis The Cardiovascular Health And Text Messaging (CHAT) Study and the CHAT-Diabetes Mellitus (CHAT-DM) Study are multicentre, single-blind, randomised controlled trials of text messaging versus standard treatment with 6 months of follow-up conducted in 37 hospitals throughout 17 provinces in China. The intervention group receives six text messages per week which target blood pressure control, medication adherence, physical activity, smoking cessation (when appropriate), glucose monitoring and lifestyle recommendations including diet (in CHAT-DM). The text messages were developed based on behavioural change techniques, using models such as the information-motivation-behavioural skills model, goal setting and provision of social support. A total sample size of 800 patients would be adequate for CHAT Study and sample size of 500 patients would be adequate for the CHAT-DM Study. In CHAT, the primary outcome is the change in systolic blood pressure (SBP) at 6 months. Secondary outcomes include a change in proportion of patients achieving a SBP 〈 140 mm Hg, low-density lipoprotein cholesterol (LDL-C), physical activity, medication adherence, body mass index (BMI) and smoking cessation. In CHAT-DM, the primary outcome is the change in glycaemic haemoglobin (HbA 1C ) at 6 months. Secondary outcomes include a change in the proportion of patients achieving HbA 1C 〈 7%, fasting blood glucose, SBP, LDL-C, BMI, physical activity and medication adherence. Ethics and dissemination The central ethics committee at the China National Center for Cardiovascular Disease and the Yale University Institutional Review Board approved the CHAT and CHAT-DM studies. Results will be disseminated via usual scientific forums including peer-reviewed publications. Trial registration number CHAT ( NCT02888769 ) and CHAT-DM ( NCT02883842 ); Pre-results.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2599832-8
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  • 3
    In: European Heart Journal: Acute Cardiovascular Care, Oxford University Press (OUP), Vol. 8, No. 3 ( 2019-04), p. 273-282
    Abstract: We examined sex differences in long-term health outcomes following acute myocardial infarction in China, including mortality, major adverse cardiac events and health status (symptoms, functioning, quality of life). Methods: A total of 3415 acute myocardial infarction patients (23.2% women) aged ⩾18 years were enrolled across 10 geographic regions in China (2012–2014) in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) study. Clinical data was abstracted from medical records. Generic (Euro-Quality of Life Scale) and disease-specific (Seattle Angina Questionnaire) health status was obtained through interviews at baseline and one year. Results: At one year, women with acute myocardial infarction had a higher risk of death from all causes ( p 〈 0.001), but had similar rates of major adverse cardiac events ( p=0.2). Women had lower mean generic (Euro-Quality of Life Scale utility index score: 0.90±0.13 vs 0.94±0.11) and disease specific health scores indicating poorer functioning (Seattle Angina Questionnaire summary score: 75.3±11.4 vs 78.4±9.7) and higher rates of daily/weekly angina (Seattle Angina Questionnaire angina frequency score ⩽60 vs 〉 60: 9.1% vs 4.7%; all p 〈 0.001). In multivariable analysis, there was a significant association between female sex and mortality (β=0.45, standard error=0.21, p=0.03) but not for major adverse cardiac events (β=−0.02, standard error=0.14, p=0.89). The association between female sex and worse generic health status persisted (β=−0.02, standard error=0.01, p=0.003), but was no longer significant between sexes for disease-specific health status (β=−0.82, standard error=0.58, p=0.154) or daily/weekly angina (odds ratio=1.39; 95% confidence interval 0.88–2.21). Conclusion: Women in China have higher crude rates of all-cause/cardiovascular death versus men, as well as worse generic/disease specific health status at one-year post-acute myocardial infarction. The association between female sex and worse generic health status persisted following adjustment.
    Type of Medium: Online Resource
    ISSN: 2048-8726 , 2048-8734
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2663340-1
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  • 4
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 12, No. 9 ( 2019-09)
    Abstract: Mobile health interventions may support risk factor management and are readily scalable in healthcare systems. We aim to evaluate the efficacy of a text messaging–based intervention to improve glycemic control in patients with coronary heart disease and diabetes mellitus in China. Methods and Results: The CHAT-DM study (Cardiovascular Health and Texting-Diabetes Mellitus) was a parallel-group, single-blind, randomized clinical trial that included 502 patients with both coronary heart disease and diabetes mellitus from 34 hospitals in China. The intervention group (n=251) received 6 text messages per week for 6 months in addition to usual care. Messages were theory driven and culturally tailored to provide educational and motivational information on glucose monitoring, blood pressure control, medication adherence, physical activity, and lifestyle. The control group (n=251) received usual care and 2 thank you messages per month. The primary outcome was change in glycated hemoglobin (HbA 1C [hemoglobin A 1C ]) from baseline to 6 months. Secondary outcomes were change in proportion of patients achieving HbA 1C 〈 7%, fasting blood glucose, systolic blood pressure, LDL (low-density lipoprotein) cholesterol, body mass index, and physical activity from baseline to 6 months. The end points were assessed using analyses of covariance. The follow-up rate was 99%. When compared with control group at 6 months, the intervention group had a greater reduction in HbA 1C (−0.2% versus 0.1%; P =0.003) and a greater proportion of participants who achieved HbA 1C 〈 7% (69.3% versus 52.6%; P =0.004). Change in fasting blood glucose was larger in the intervention group (between-group difference: −0.6 mmol/L; 95% CI, −1.1 to −0.2; P =0.011), but no other outcome differences were observed. Nearly all participants reported that messages were easy to understand (97.1%) and useful (94.1%). Conclusions: A text message intervention resulted in better glycemic control in patients with diabetes mellitus and coronary heart disease. While the mechanism of this benefit remains to be determined, the results suggest that a simple, culturally sensitive mobile text messaging program may provide an effective and feasible way to improve disease self-management. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02883842.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2453882-6
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  • 5
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 12, No. 4 ( 2019-04)
    Abstract: Mobile health technologies are low cost, scalable interventions with the potential to promote patient engagement and behavior change. We aimed to test whether a culturally sensitive text messaging intervention supporting secondary prevention improves the control of risk factors in patients with coronary heart disease in China. Methods and Results: In this multicenter, single-blinded randomized controlled trial, 822 patients (mean age, 56.4 [SD, 9.5] years; 14.1% women) with coronary heart disease and without diabetes mellitus from 37 hospitals in China were enrolled between August 2016 and March 2017. In addition to usual care, the control group (n=411) received 2 thank you messages/month; the intervention group (n=411) received 6 text messages/week for 6 months delivered by an automated computerized system. The messages provided educational and motivational information related to disease-specific knowledge, risk factor control, physical activity, and medication adherence. The primary end point was change in systolic blood pressure from baseline to 6 months. Secondary end points included the proportion with systolic blood pressure 〈 140 mm Hg, smoking status, and change in body mass index, LDL-C (low-density lipoprotein cholesterol), and physical activity (assessed using the International Physical Activity Questionnaire). The end points were assessed using analyses of covariance. Follow-up was 99.6%. At 6 months, systolic blood pressure was not significantly lower in the intervention group compared with the control group, with a mean change (SD) of 3.2 (14.3) mm Hg and 2.0 (15.0) mm Hg ( P 〉 0.05) from baseline, respectively (mean net change, −1.3 mm Hg [95% CI, −3.3 to 0.8]; P =0.221). There were no significant differences in the change in LDL-C level, physical activity, body mass index, or smoking status between the 2 groups. Nearly all patients in the intervention group reported the text messages to be useful (96.1%), easy to understand (98.8%), appropriate in frequency (93.8%), and reported being willing to receive future text messages (94.8%). Conclusions: Text messages supporting secondary prevention among patients with coronary heart disease did not lead to a greater reduction in blood pressure at 6 months. Mobile phone text messaging for secondary prevention was feasible and highly acceptable to patients. Clinical Trial Registration: URL: https://clinicaltrials.gov . Unique identifier: NCT02888769.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2453882-6
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  • 6
    In: SSRN Electronic Journal, Elsevier BV
    Type of Medium: Online Resource
    ISSN: 1556-5068
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
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  • 7
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 12, No. Suppl_1 ( 2019-04)
    Abstract: Background: Mobile health technologies are low-cost, scalable interventions with the potential to promote patient engagement and behavior change. We designed and tested a tailored culturally-sensitive text messaging intervention to support secondary prevention in patients with coronary heart disease. Methods: In this multi-center, single-blinded randomized controlled trial, we enrolled 822 patients (mean age, 56.4 [SD, 9.5] years; 16.1% [132 of 822] women) with a history of AMI or PCI and without diabetes from 37 hospitals in China from August 2016 to March 2017. In addition to usual care, the control group (n=411) received 2 thank-you messages/month; the intervention group (n=411) received 6 text messages/week for 6 months delivered by an automated computerized system. The messages provided educational and motivational information related to disease-specific knowledge, risk factor control, physical activity and medication adherence. The primary endpoint was change in systolic blood pressure (SBP) from baseline to 6 months. Secondary end points included the proportion with SBP 〈 140mmHg, smoking status, and change in BMI, LDL-C, and physical activity. The endpoints were assessed using analyses of covariance. Results: Follow up was 99.6% (819 of 822). The mean baseline SBP (SD) for the intervention and control groups were 130.9 (15.1) mmHg and 131.4 (17.5) mmHg, respectively. At 6 months, SBP was not significantly lower in the intervention group compared to the control group (mean SBP 127.8 vs. 129.4mmHg, p=0.089), with a mean change (SD) of 3.2 (14.3) mmHg and 2.0 (15.0) mmHg from baseline, respectively (mean net change -1.3mmHg [95%CI -3.3 to 0.8]; P=0.221). There were no significant differences in the change in LDL-C level, physical activity, BMI or smoking status between two groups. Nearly all patients in the intervention group reported the text messages to be useful (96.1%[389 of 405] ), easy to understand (98.8%[400 of 405]), appropriate in frequency (93.8%[380 of 405] ), and reported being willing to receive future text messages (94.8%[384 of 405]). Conclusions: Text messages supporting secondary prevention among patients with CHD did not lead to a greater reduction in blood pressure at 6 months. However, it was feasible and highly acceptable to patients.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2453882-6
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