Tweeting Our Way to Cardiovascular Health

To the Editor: Exponential growth in Internet use and smartphone ownership has seen the rapid expansion of social media interfaces, such as Twitter, for rapid and global information sharing. Twitter, a real-time information network that connects people, is becoming increasingly popular. Twitter posts, known as Tweets, are limited to 140 characters but often include links to more detailed information via Websites and photographs. Twitter's popularity has dramatically increased since its inception, with approximately 55 million messages, or “Tweets,” being sent daily from about 500 million users worldwide (1).

Twitter works by users posting Tweets to their “followers” (other Twitter users who have agreed to receive a person's Tweets). Therefore, the more followers a Twitter user has, the more people will receive their Tweets. The potential reach of Twitter is realized when the user has many followers and if those followers resend Tweets to their followers. This process is known as re-tweeting. In recent years, a growing number of health professionals have been using social media to share information. In a survey of 485 oncologists and physicians, 24% used social media at least daily to scan or explore medical information (2). Recent studies have also reported significant growth in the use of Twitter for social networking and microblogging about medical information, including quitting smoking (3) and epileptic seizures (4). The unique ability of Twitter to disseminate critical information quickly has also been attributed to saving many lives during the recent earthquakes in Japan (5). The current study sought to investigate the growth, reach, and content of Twitter accounts for international professional organizations and prominent scientific journals associated with cardiovascular medicine.

Fifteen international Twitter accounts (9 professional organizations and 6 medical journals) were selected for analysis of Twitter growth, reach, and content. The number of followers and corresponding growth for each account over 12 months (October 31, 2011 to October 31, 2012), and the reach of 50 recent Tweets for each account, were measured by using the analytical software Twitter Counter (Amsterdam, the Netherlands) and Tweetreach (San Francisco, California). Reach was defined as the number of unique people who received the 50 original Tweets for each account; hence, it is a measure of the number of followers each person who re-tweets items has.

To examine content, we randomly selected up to 50 recent Tweets from each of the 15 accounts during the 12-month study period. Each Tweet was coded by 3 independent reviewers as either being directed at fundraising, social activities, health professional education, or consumer health information or for marketing purposes.

The 15 Twitter accounts had a total of 674,787 followers in October 2011 and 1,318,601 followers 1 year later, representing a mean increase of 57% (Table 1). Ten of the 15 accounts experienced growth in followers of more than 50%. In terms of reach, a total of 1,200,865 Twitter users eventually received the 50 Tweets per account. Several accounts achieved a re-tweet from a user with a large number of followers. For example, the New England Journal of Medicine had 1 Tweet re-tweeted by a user with 560,000 followers.

A total of 690 Tweets were coded for content (including 420 sent from organizational accounts and 270 from journal accounts). For the Sudden Arrhythmia Death Syndromes Foundation and for Heart, only 20 Tweets could be downloaded. In total, the coded Tweets focused on health professional education (407 of 690 [59%]), consumer education (133 of 690 [19%]), marketing (74 of 690 [11%]), social communication (44 of 690 [6%]), and fundraising (32 of 690 [5%]). The organizations focused on health professional (205 of 420 [49%]) and consumer (106 of 420 [25%]) education whereas the journals directed the majority of content at health professional education (202 of 270 [75%]).

This study illustrates the emerging role of Twitter as a medium by which cardiovascular health information and education can be disseminated quickly, efficiently, and on a worldwide scale. Our study illustrates that Twitter not only encompasses health professionals but also professional organizations such as the American College of Cardiology, key journals, and patients themselves. Our current findings support the notion that Twitter can facilitate rapid and expansive dissemination of information.

Real-time networking, using interfaces such as Twitter, provide an enticing and free opportunity for information exchange on a global scale; such networking has excellent potential to connect people and organizations to enhance education, awareness, and overall management of cardiovascular disease. The benefits are particularly relevant in terms of promotional activities, awareness of health-related issues, and for interactivity at scientific meetings. The potential to harness free social media infrastructure that allows live, interactive, and international communication is both fascinating and unique.

• American College of Cardiology Foundation