Study finds that 60 percent of patients do not survive beyond the first month

As India has a high burden of stroke, a mobile health (mHealth) strategy used for intervention to reduce second stroke shows changes in lifestyle and behavioural factors can have substantial long-term effects on cardiovascular events and mortality.

Mobile health (mHealth) is a popular strategy that has been used to control cardiovascular risk factors in stroke patients.

High recurrent stroke rates range from 15 percent to 21 percent in the population and hospital-based registries.

Together, recurrent stroke and coronary artery disease are the major predictors of mortality in India, and with 60 percent mortality at one month after the stroke.

Adult patients with first stroke and access to a mobile cellular device were randomly selected for the intervention in a multicentre, randomised, clinical trial conducted in 31 centres of the Indian Stroke Clinical Trial Network (INSTRuCT). They received regular short SMS messages and videos that promoted risk factor control and medication adherence and an educational workbook, in one of 12 languages.

An earlier study had indicated that the use of short, customised text messages, such as medication reminders and sporadic health and lifestyle messages, may have a positive impact on medication adherence for the management of cardiovascular risk factors.

The latest study was the first trial done within the INSTRuCT network. The follow-up duration planned for the study was 12 months. However, it was noted about 15 percent of events occurred after one year.

Acknowledgment of receipt of the SMS messages and videos by patients was low (17 percent), the study says.

“Apart from the missed-call acknowledgment and the fidelity questionnaire, we did not have a definite means of confirming that the patients had watched the videos or read the SMS messages.”

The study points out that for patients who were primarily dependent on their carers, there was no way to verify if the SMS messages or films were shared with or watched by the stroke patient themselves.

The centres involved in the study were all located in urban areas.

“This trial showed that a well-designed intervention can contribute to improving some of the secondary prevention factors including behavioural outcomes (alcohol cessation and smoking cessation) and medication adherence, which might provide long-term benefits,” the study explains.

Lifestyle-focused text messaging on risk factor modification has reduced systolic blood pressure, low-density lipoprotein, cholesterol, BMI, increased physical activity, and improved smoking habits in individuals with coronary artery disease.

Hypertension, diabetes mellitus, smoking, inadequate physical activity, cardiac causes, dyslipidaemia, obesity, and alcohol consumption are some of the major risk factors for stroke globally.

A relative reduction of 10 percent in alcohol use and of 30 percent in tobacco use in adults has been outlined as a target for 2025 by the Indian National Non-Communicable Disease Monitoring Framework.

Also Read: Can a neck massage or hair salon sink wash be a stroke risk?