Background Coronary heart disease (CHD) is the leading cause of death and disability among American women. The prevalence of CHD is expected to increase by more than 40% by 2035. In 2015, the estimated cost of caring for patients with CHD was US $182 billion in the United States; hospitalizations accounted for more than half of the costs. Compared with men, women with CHD or those who have undergone coronary revascularization have up to 30% more rehospitalizations within 30 days and up to 1 year. Center-based cardiac rehabilitation is the gold standard of care after an acute coronary event, but few women attend these valuable programs. Effective home-based interventions for improving cardiovascular health among women with CHD are vital for addressing this gap in care. Objective The ubiquity of mobile phones has made mobile health (mHealth) behavioral interventions a viable option to improve healthy behaviors of both women and men with CHD. First, this study aimed to examine the usability of a prototypic mHealth intervention designed specifically for women with CHD (herein referred to as HerBeat). Second, we examined the influence of HerBeat on selected health behaviors (self-efficacy for diet, exercise, and managing chronic illness) and psychological (perceived stress and depressive symptoms) characteristics of the participants. Methods Using a single-group, pretest, posttest design, 10 women participated in the 12-week usability study. Participants were provided a smartphone and a smartwatch on which the HerBeat app was installed. Using a web portal dashboard, a health coach monitored participants’ ecological momentary assessment data, their behavioral data, and their heart rate and step count. Participants then completed a 12-week follow-up assessment. Results All 10 women (age: mean 64.4 years, SD 6.3 years) completed the study. The usability and acceptability of HerBeat were good, with a mean system usability score of 83.60 (SD 16.3). The participants demonstrated statistically significant improvements in waist circumference (P=.048), weight (P=.02), and BMI (P=.01). Furthermore, depressive symptoms, measured with the Patient Health Questionnaire-9, significantly improved from baseline (P=.04). Conclusions The mHealth prototype was feasible and usable for women with CHD. Participants provided data that were useful for further development of HerBeat. The mHealth intervention is expected to help women with CHD self-manage their health behaviors. A randomized controlled trial is needed to further verify the findings.

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C enter-based cardiac rehabilitation (CBCR), the gold standard of secondary prevention (SP) of coronary heart disease (CHD), 1 provides irrefutable health benefits. 2 Support for healthy behavior change is a vital component of contemporary CBCR. 3 However, fewer women than men are referred to CBCR 4,5 and as few as 10-20% of women enroll with up to a 56% noncompletion rate. [6][7][8][9] Welldocumented barriers contribute to the underutilization of CBCR 10 including inadequate health insurance and costly copayments. 11 Women with transportation challenges, less social support, family obligations, depression, or anxiety and women of color are least likely to utilize CBCR. 8,[12][13][14] These barriers have prompted the need to redesign and expand SP alternatives for women. [15][16][17] Individualized SP programs that incorporate sex-specific components hold promise for improving the health behaviors of women. [18][19][20] Moreover, mobile health (mHealth) technology has the potential to increase scalability of SP through broader reach seamlessly in daily life and improved intervention effectiveness. 21 Although technology-enhanced home-based cardiac rehabilitation (CR) offers a possible adjunct to poor CBCR participation, 22 evidence for improved reach and effectiveness for women is limited. 23 Theoretically driven mHealth SP interventions designed specifically for women unable to access CBCR are lacking. 24 Our previously developed gender-specific CBCR 25,26 was translated to a gender-specific mHealth SP behavior change intervention, called HerBeat. Descriptions of the theoretical underpinnings, system architecture, and usability testing of our prototype are found elsewhere. 27,28 HerBeat focuses on improving the health behaviors of women (eg, physical activity [PA], eating behavior, and stress management). Our primary aim was to evaluate, in a randomized controlled pilot study, whether participants in the HerBeat compared with participants in the educational usual care (E-UC) group improved exercise capacity (EC) at 3 mo measured by the 6-min walk test (6MWT). Secondary outcomes included PA, blood pressure (BP), resting heart rate (RHR), body mass index (BMI),