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Participants were randomly allocated to either the intervention or the control arms in a 1:1 ratio using a computerised randomisation system.In order to achieve a balance of participants’ characteristics in both arms, we employed a stratified randomisation approach, based on age, gender, AMI history, education degree and medical insurance type within each study.The two studies were registered at and NCT02883842) accordingly.We retrospectively registered the trial 7 days later after enrolment of the first patient in CHAT Study , beyond the International Committee of Medical Journal Editors (ICMJE) recommendations of the journal, as we referred to the Food and Drug Administration (FDA) AA801 public law on the website that clinical trials are registered no later than 21 days after the first patient was enrolled.The control group in both studies receive two thank you text messages without risk factor modification support each month as well as standard treatment.
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).
Patients were recruited from 37 hospitals across 17 provinces in China (figure 1, online supplementary material 1).
The enrolment of participants began on 16 August 2016.
See: The benefits of secondary prevention strategies for coronary heart disease (CHD) targeting lifestyle modification and risk factor management are well established worldwide,1 2 however adoption of these strategies is suboptimal.3 Smoking, inactivity and obesity are prevalent among people with established CHD and control of hypertension and diabetes are often suboptimal. Prior studies revealed that only three-fourths of all hospitalised patients take all medications from their discharge prescriptions by 120 days after discharge.4 Furthermore, less than half of patients hospitalised with acute myocardial infarction (AMI) are adherent to evidence-based medications 1 year later, with the greatest gaps in adherence occurring in the first 6 months after treatment initiation.5–7 In lower-income and middle-income countries (LMICs), including China, which face a growing burden of cardiovascular disease and greater challenges to medication access for secondary prevention, over two-thirds of patients with CHD take no medication.8–10 While high medication costs are a barrier,11 there is also limited time for education and consultation regarding lifestyle and medication management during clinic visits, which tend to be very brief.12 13 Therefore, innovative and cost-effective interventions to enhance adherence are urgently needed.
Mobile phones are pervasive and thus can be used to deliver interventions that help people adopt secondary prevention strategies for CHD in LMICs.