Digital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review

Abstract

Background Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR. Objective The objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions. Methods Our strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018. Results Our search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure. Conclusions Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions.

Does Connected Health Technology Improve Health-Related Outcomes in Rural Cardiac Populations? Systematic Review Narrative Synthesis

“…Databases were searched for literature published from January 1990–June 2021. This search date was selected because it was unlikely that connected technologies would be reported on prior to this date, and this timeframe was used by Wongvibulsin et al (2021) [ 18 ], who investigated digital health interventions for CR. Articles had to be in or translatable into English.…”

“…Technological advances have allowed the development of CR conducted at the patient’s home, to increase accessibility [ 17 ]. Previous reviews have been conducted into the effectiveness of technology within rehabilitation settings [ 18 , 19 ], though there has been little consideration of rural patients. Understanding what effect technologies can have for rural residents living with CVD is important due to the range of barriers associated with physical activity and health care accessibility.…”

“…In home settings, smartphone-based interventions have been shown to improve attendance and completion of CR programmes [ 21 ]. Another form of technology frequently employed within health care settings are ‘digital health interventions’, which is an overarching term used by Wongvibulsin et al (2021) [ 18 ] to describe ‘telemedicine, telehealth and eHealth.’ Such methods allow patients to communicate with healthcare professionals through mediums such as email, audio, or video [ 22 ]. Telehealth also allows the delivery of online exercise programmes at distance and Rawstorn et al (2016) [ 23 ] found CR telehealth interventions to be ‘at-least’ as effective in improving CVD risk factors and functional capacity in comparison to centre-based CR.…”

Mobilizing artificial intelligence to cardiac telerehabilitation

“…To address the inconsistent views about the patients' exercise adherence in cardiac telerehabilitation, further research is necessary. Therefore, more comprehensive tracking and interpreting are necessary for long-term follow-up of cardiac telerehabilitation [73]. As the special period with the coronavirus disease will probably continue for a long period [74], it is increasingly important to explore AI more in the longitudinal follow-up of cardiac telerehabilitation.…”

Barriers and facilitators to participating in cardiac rehabilitation and physical activity: A cross-sectional survey

“…Developing new methods to increase attendance at exCR is deemed paramount[ 5 ]. Such methods could include telehealth, remote monitoring, or a hybrid approach, to increase accessibility and participation[ 6 ].…”