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Background: Smartphone apps and mHealth devices offer innovative ways to collect cardiovascular data. However, maintaining engagement is challenging. We assessed the effect of interventions to enhance remote transmission of blood pressure (BP) and heart rate (HR) data.

Methods: We conducted a 2x2x2 factorial blinded randomized trial (NCT03516019). We invited eFHS participants, an e-cohort embedded in the Framingham Study, to enroll. We trained participants to wear their smartwatch (Apple Watch) daily and measure their BP (Withings) weekly. We sent weekly notifications to promote adherence. We assessed 3 notification strategies: personalized vs. standard; weekday vs. weekend; and morning vs. evening. Personalized notifications included the participant’s name and were tailored to prior week’s data transmission. Primary outcomes were adherence to HR and BP transmission in the week following the 12th notification (3-month). Secondary outcomes were 1- and 6-month adherence.

Results: We randomized 655 participants (54±9 years, 60% women). For the personalized vs. standard notification primary outcomes, there was no evidence of difference for HR data transmission (64.1% vs. 62.4%; p=0.65), but 38.7% vs. 28.8% participants sent BP data (difference, 9.9%; 95%CI 2.7-17.0%; p=0.008). Personalized notifications were associated with increased HR transmission at 6 months (59.8% vs. 49.2%, difference 10.6%; 95%CI 2.8-18.2%; p<0.01). For HR and BP primary or secondary outcomes, there was no evidence of a difference between notifications sent on weekday vs. weekend, or morning vs. evening. We did not observe two-way or three-way interactions.

Conclusion: Our trial demonstrated that personalized notifications increase adherence to BP and HR transmission from mobile and digital devices among eFHS participants. Our results suggest that personalized messaging is a powerful tool to promote adherence to mHealth systems in cardiovascular research.

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