Cardiac syndrome X (CSX) is regarded as a form of ischemic heart disease (1). Functional coronary microvascular abnormalities, often associated with endothelial dysfunction, results in a reduced coronary blood flow reserve (2, 3, 4). Besides, the formation of atherosclerotic plaque inside the wall of the coronary arteries is a hallmark of coronary artery disease (CAD) which leads to narrowing of the vessels and subsequently into the clinical demonstrations of the acute coronary syndrome including angina and myocardial infarction (4, 5). It happens due to the abnormal functioning of coronary microvasculature (7, 8). In addition, CSX is highly prevalent all around the world as well as in Iran (6, 8). A large patient cohort study by American Heart Association stated that among participants suspected to have myocardial ischemia and referred for coronary artery disease (CAD), 41% of the females and only 8% of the males showed non-significant epicardial CAD. Approximately 18.2 million adults (> 20 years old) have CAD (about 6.7%). Likewise, it is estimated that 2 out of 10 deaths due to CAD occur in adults (< 65 years old) (9, 10, 11).
Likewise, CSX incidence in patients undergoing invasive diagnostics for coronary heart disease was estimated at approximately 20–30%. About 60–70% of patients with CS X are female, often of menopausal age (12, 13). According to the WHO report in a local setting, CAD is the number one killer among Iranian people which contributes to around 46% of all deaths (14). While, although CSX is not associated with an increased risk of death, it has a sign in a patient’s functioning and quality of life. However, CSX symptoms are often debilitating and due to which most of its patients have a poor quality of life and frequently demand costly healthcare services. (15, 16, 17). CSX attributes are comprised of female predominance, typical and atypical features of chest pain, high prevalence of psychological disorders, and recurrent hospital admissions (20, 21, 22). Many patients remain symptomatic despite reassurance, with significant limitations in their daily life activities usually due to persistent chest pain. Functional disability affects approximately 75% of patients with syndrome X, and the majority of these patients usually receive treatment with multiple drug combinations (23, 24, 25). Therefore, this apparent and short-term condition seems to affect negatively the quality of life (25). Compelling evidence indicates that in such societies besides drug treatment and targeting risk factors, a healthy lifestyle is an effective and important approach for the primary prevention of CSX diseases (26, 27). Researchers have suggested that Knowledge of the patient’s individual risk factors can play a useful role in clinical decision-making regarding the intensity of preventive interventions and in guiding individualized management and control of these factors (26, 28). The pursuit of lifestyle changes using health education strategies is a necessary step in reducing cardiovascular events (29, 30, 31). Hence, educational programs and Lifestyle modification represent a highly effective and low-cost intervention that can reduce the incidence, progression, and morbidity associated with CSX (27, 32, 33, 34). One of the most effective strategies is to emphasize the improvement of knowledge regarding risk factors of heart diseases and attitude towards CS X risk factors and adherence to a healthy lifestyle (35,36,37 38, 39, 40).
One of the revolutionary technology in the 21st century is mobile technology which has created a large revolution in the field of science and transfer of knowledge and technology. Mobile health (mHealth) is an alternative approach that is being used due to its low cost and wide accessibility. Hence, mHealth could advance health care for patients, providers, and policymakers (41, 442, 43,) Mobile devices have created a new communication channel between healthcare service providers and patients. However, the benefits of mobile devices in healthcare exceed beyond the communication channels. They enable better coordination, improve diagnostic accuracy, and build a bridge of trust (43, 44, 45). Besides, technological innovations have already been used to bridge health disparities and consumer health, empowering patients to take control and play an active role in managing their health as well as enhance the knowledge of the patients (27, 46, 47). Hence, there is developing evidence that mHealth interventions are an effective and acceptable means of improving quality of life and adherence to a healthy lifestyle (27, 43).
Meanwhile, mobile phones can deliver health-improving facilities via short messaging service (SMS), smartphone applications (apps), or video messaging (47, 48, 49). Through the research team of electronic databases CINAHL (Cumulative Index of Nursing and Allied Health Literature), identified key findings regarding mHealth interventions and health information considered suitable to the study setting and they have suggested that mHealth can be useful tools for health instructional intervention (45, 46). Due to a high prevalence and a large rise in cardiovascular diseases in recent years, more attention is necessary by the Ministry of Health and Education of Iran to give priority to research exploring strategies for the reduction of cardiovascular morbidity and mortality (2, 6). Alternately, it could reduce health care costs and also reduce the waste of medical resources (29, 30). Therefore, mobile health applications pose a great potential in health promotion and increasing knowledge about a healthy lifestyle while reducing costs affect health care (44, 45, 48). Considering that, yet there is no definitive treatment for CSX disease and also there is a lack of guidelines outlining the best course of therapy for modification of their lifestyle (1, 3). Hence, healthcare providers and the health care systems may discover this study to be helpful in creating a new protocol or policies that can improve cardiac patients’ knowledge and quality of life (49, 50). The mobile health messaging apps (as a mandatory healthcare intervention) assist in the knowledge transfer between healthcare providers and patients. More knowledge and items can be provided to patients through this platform to improve adherence to a healthy lifestyle and their quality of life. So far in Iran, there have been few studies regarding this subject. To date, there has been no study related to the effect of mobile messaging apps on CSX patients in Iran. In sum, the researcher has suggested that the mHealth Messages App is useful and cost-effective for promoting health education.