Mobile Communication Technologies to Improve Secondary Prevention of Coronary Heart Disease

Coronary heart disease (CHD) is the leading cause of death worldwide. Prevention strategies are extremely important to reduce the burden of CHD, especially in those who have had a previous cardiovascular event, as they are at greater risk of having a recurrent event and are more likely to die in the recurrent event. Despite the clear benefits of preventive care, many CHD patients fail to receive and adhere to the guideline recommendations, including lifestyle modification and adherence to evidence-based medications. Prevention programmes, such as cardiac rehabilitation, are effective in improving CHD morbidity and mortality. However, such programmes are under-utilised due to several barriers. Therefore, there is a need for innovative approaches in CHD preventive care. The use of mobile communication technologies in healthcare, often termed mHealth, presents a promising strategy to deliver prevention interventions to large numbers of people. This thesis aimed to investigate the use of mobile communication technologies to improve secondary prevention of CHD. Findings of this thesis suggest that mHealth can improve healthcare by delivering preventive interventions to patients with CHD. Two potential modes of preventive programme delivery are text-messages and smartphone applications (apps). A lifestyle-focused text-messaging intervention investigated in the TEXT ME Study was found to be effective in improving heart-healthy dietary patterns in patients with CHD. In addition, the use of medication reminder apps was shown to improve medication adherence in patients with CHD and no significant differences were found between an advanced and a basic medication reminder apps. In conclusion, mHealth interventions improved both lifestyle modification and medication adherence components of secondary prevention of CHD. Future research is needed to confirm and expand these findings in larger longer-term RCTs