Avaliação do impacto do uso de mensagens de texto por telefone na prevenção secundária da Síndrome Coronariana Aguda: um subestudo do Projeto Boas Práticas Clínicas em Cardiologia

Abstract

Introduction: Short message service (SMS) programs to promote healthcare have shown beneficial results for the control of cardiovascular risk factors, but evidence is lacking in low and middle-income countries. The purpose of this study is to evaluate whether the use of SMS increases risk factor control within six months after discharge by acute coronary syndrome (ACS) in a Brazilian Public University Hospital, which participates in a program of quality assistance, the Good Practice Program in Cardiology. Methods: We conducted a 2-arm, parallel, double-blind, randomized trial that enrolled 180 patients (>18 years) admitted due to ACS at a Public General Hospital in Brazil. Eligible patients were randomized (1:1) to a SMS intervention (G1) or standard discharge cardiovascular care (G2). The primary outcome was achieving 4 or 5 points in a risk factor control score, consisting of a cluster of 5 modifiable risk factors: LDL-C <70mg/dL, blood pressure (BP) <140/90mmHg, regular exercise (≥5 days/week, 30 minutes/session), nonsmoker status, and body mass index (BMI) <25 kg/m2] at 6 months. Results: From randomized patients, 147 were included in the final analysis. Mean age was 58 (51–64) years, 74% males. Diagnosis at admission was ST elevation myocardial infarction in 122 (68%), and 25% with Killip class ≥2. The primary outcome was achieved by 12 (16.2%) patients in G1 and 15 (20.8%) in G2 (OR=0.73, 95%CI 0.32–1.70, p=0.47). Secondary outcomes were also similar: LDL-C<70 mg/dl (p=0.33), BP<140/90 mmHg (p=0.32), non-smoker (p=0.74), regular exercise (p=0.97), BMI (p=0.71), rehospitalization (p=0.06). All-cause death occurred in 3 participants (2%), including 1 cardiovascular death in each group. Conclusion: In patients discharged after ACS, the SMS intervention did not significantly improve cardiovascular risk factor control at 6 months compared to standard care in a hospital where post-ACS outpatient care is already structured. However, the number of patients studied was small and the results cannot be considered definitive.