Telegram Messenger Support for Smoking Cessation After Heart Attack

The TELEGRAM-MI trial is a multicenter, randomized, controlled, assessor-blinded superiority study testing a digital behavioral intervention for smoking cessation in post-myocardial infarction patients.

BACKGROUND: Smoking cessation is the most effective modifiable risk factor for reducing mortality after MI, yet long-term abstinence remains challenging due to limited sustained support. Digital interventions using popular messaging platforms offer a scalable solution to bridge the post-discharge support gap.

OBJECTIVES:

Primary: To determine if a 6-month Telegram chatbot intervention increases 30-day point prevalence abstinence rates at 6 months compared to standard care alone.

Secondary: To examine associations between baseline characteristics (nicotine dependence, motivation), engagement metrics, and cessation success; and to assess intervention acceptability.

METHODS: Approximately 142 participants will be recruited from inpatient cardiology departments. After providing informed consent, participants will be randomized 1:1 via the chatbot to either the intervention group (standard care plus 6-month behavioral support) or control group (standard care plus data collection only). The intervention incorporates evidence-based techniques including motivational messaging, cognitive-behavioral strategies, and relapse prevention protocols.

OUTCOMES: The primary outcome is biochemically unverified 30-day point prevalence abstinence at 6 months, assessed via blinded telephone interview with participant and relative verification. Secondary outcomes include various smoking behavior metrics collected through the chatbot platform.

ANALYSIS: Primary analysis will follow intention-to-treat principles, with missing data imputed as smoking. Statistical analyses will include chi-square tests for primary outcome and regression models for secondary outcomes.

POTENTIAL IMPACT: If effective, this intervention represents a readily implementable, low-cost strategy to enhance secondary prevention in cardiac patients.

Inclusion criteria

• Willing and able to provide written informed consent.
• Age 18 years or older.
• Hospitalization with a confirmed diagnosis of acute myocardial infarction (MI), including both ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI).
• Current smoker at the time of index MI: self-reported smoking of at least one cigarette per day in the month prior to hospitalization.
• Regular user of the Telegram messenger application (app installed on a personal smartphone).
• Possession of a smartphone with internet access and a valid phone number.
• Ability and willingness to provide contact information for a close relative or cohabiting person who can verify smoking status at follow-up.

Exclusion criteria

• Smoking cessation more than 1 month prior to the index MI hospitalization.
• Physical or cognitive impairment that prevents the use of a smartphone (e.g., severe visual/hearing impairment, inability to read or respond to messages).
• Inability to read and understand the Russian language fluently.
• Comorbid condition with a life expectancy of less than 1 year.
• Active severe mental illness (e.g., psychosis, severe untreated depression) that would impede understanding of the protocol or adherence.
• Unwillingness or inability to provide contact details for a close relative for outcome verification.