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In CHAT, patients were eligible if they had established CHD defined as a history of AMI and/or percutaneous coronary intervention, access to a mobile phone to read and send text messages, and did not have diabetes.In CHAT-DM, patients were eligible if they had a history of documented CHD (as defined in CHAT) and diabetes, and had access to a mobile phone to read and send text messages.They are a primary, inexpensive and quick form of communication, and are widely used to schedule alerts and reminders.In addition, the number of mobile phone users has grown exponentially in the past decade worldwide, and is projected to reach 4.77 billion by 2017.14 As of August 2016, China had the largest number of mobile phone owners in the world, at 1.3 billion.15 Mobile phones are also used across all geographical regions and income levels.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.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.

A ‘screening log’ of basic demographic information and reasons for not participating in patients deemed ineligible or declined to participate has been recorded.The recruitment was completed in April 2017, and the last follow-up visit is expected to finish in October 2017.All participants provided written informed consent at the initial trial visit.The primary objective of these two studies is to evaluate the efficacy of an automated text message-based intervention, based on BCTs, in improving risk factor control and adoption of healthy lifestyle behaviours among patients with known CHD, with or without DM, who were discharged from multiple hospitals throughout China.The CHAT and CHAT-DM studies are multicentre, single-blind, two-arm, randomised controlled trials of an automated mobile phone text message-based intervention with 6 months of follow-up.The control group in both studies receive two thank you text messages without risk factor modification support each month as well as standard treatment.A training session was held by research staff on enrolment to ensure that all participants were capable of receiving, reading and sending text messages on their mobile phones.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.Due to their ubiquity and convenience, nearly 200 000 mobile phone messages are sent every second in China.16 As such, text messaging has the potential to be a scalable and powerful tool to deliver health information.17 18 Prior studies of mobile phone text messaging have been conducted to improve glycaemic control,19 hypertension,20 medication adherence,21 as well as to promote smoking cessation22 and physical activity.23 24 These trials have contributed important knowledge, and some, such as The Tobacco, Exercise and Diet Messages (TEXT-ME) trial25 and Trial to Examine Text-based m Health for Emergency department patients with Diabetes (TEx T-MED)26 suggest that text messaging interventions can influence patient behaviours and improve risk profiles.Still, several questions remain about the generalisability of these findings, especially for populations from LMICs.

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