Effectiveness of Mobile Health Augmented Cardiac Rehabilitation (MCard) on health-related quality of life among post-acute coronary syndrome patients: A randomized controlled trial

Abstract

Objectives: To determine the effectiveness of Mobile health augmented Cardiac rehabilitation (MCard) on health-related quality of life (HRQoL) among post-acute coronary syndrome (post-ACS) patients.
 Methods: At the Armed Forces Institute of Cardiology (AFIC), a tertiary care hospital in Rawalpindi, Pakistan, a two-arm randomised controlled trial was conducted in which mobile health augmented cardiac rehabilitation (MCard) was developed and implemented on post-ACS patients from January 2019 until March 2021. The trial conforms to the CONSORT statement 2010. The post-ACS patients were randomly allocated (1:1) to an intervention group (received MCard; counselling, empowering with self-monitoring devices, short text messages, in addition to standard post-ACS care) or control group (standard post-ACS care). HRQoL was assessed by generic Short Form-12 and MacNew quality of life myocardial infarction (QLMI) tools. Participants were followed for 24 weeks with data collection and analysis at three time points (baseline, 12 weeks and 24 weeks).
 Results: At baseline, 160 patients (80 in each group; mean age 52.66±8.46 years; 126 male, 78.75%) were recruited, of which 121(75.62%) continued and were analysed at 12-weeks and 119(74.37%) at 24-weeks. The mean SF-12 physical component score significantly improved in the MCard group at 12 weeks follow-up (48.93 vs control 43.87, p<.001) and 24 weeks (53.52 vs 46.82 p<.001). The mean SF-12 mental component scores also improved significantly in the MCard group at 12 weeks follow-up (44.84 vs control 41.40, p<.001) and 24 weeks follow-up (48.95 vs 40.12, p<.001). At 12-and 24-week follow-up, all domains of MacNew QLMI (social, emotional, physical and global) were also statistically significant (p<.001) improved in the MCard group, unlike the control group.
 Conclusion: MCard is an effective and acceptable intervention at improving all domains of HRQoL. There was an improvement in physical, mental, social, emotional and global domains among the MCard group in comparison to the control group. The addition of MCard programs to post-ACS standard care may improve patient outcomes and reduce the burden on the health care setting.
 doi: https://doi.org/10.12669/pjms.38.3.4724
 How to cite this:Hisam A, Zia-ul-Haq, Aziz S, Doherty P, Pell J. Effectiveness of Mobile Health Augmented Cardiac Rehabilitation (MCard) on health-related quality of life among post-acute coronary syndrome patients: A randomized controlled trial. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4724
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The Effects of mHealth Interventions on Quality of Life, Anxiety, and Depression in Patients With Coronary Heart Disease: Meta-Analysis of Randomized Controlled Trials

“…Given the nature of the mHealth intervention, participants and personnel were blinded in only 4 (17%) of the 23 studies [ 37 , 39 , 46 , 47 , 55 ]. In 13 (57%) of the 23 studies [ 24 , 26 , 27 , 35 - 37 , 40 , 44 - 48 , 55 ], the outcome assessors were blinded. Of the 23 studies, 2 (9%) were grade A (low bias), and 21 (91%) were grade B (moderate bias; Figure 2 ; Figure S1 in Multimedia Appendix 2 ) [ 24 - 27 , 35 - 53 ].…”

“…The 23 RCTs selected [24][25][26][27][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] included 5406 participants (n=2708, 50.09% participants in the intervention groups and n=2698, 49.91% in the control groups), with sample sizes per study varying from 51 to 1424. All patients with CHD in the 23 RCTs were in the cardiac rehabilitation (CR) stage, including those who had undergone revascularization procedures (such as coronary artery bypass grafting or percutaneous transluminal coronary angioplasty) as well as patients with CHD confirmed through angiography.…”

“…All patients with CHD in the 23 RCTs were in the cardiac rehabilitation (CR) stage, including those who had undergone revascularization procedures (such as coronary artery bypass grafting or percutaneous transluminal coronary angioplasty) as well as patients with CHD confirmed through angiography. The RCTs were conducted in Asia (12/23, 52%) [27,[37][38][39][40][41]43,45,[48][49][50][51], Europe (6/23, 26%) [25,26,35,42,44,47], and Australia and New Zealand (5/23, 22%) [24,36,46,52,53]. Of the 23 studies, 19 (83%) reported QoL, 13 (57%) reported anxiety, and 17 (74%) reported depression (Tables 1 and 2).…”

“…The Cochrane Handbook for Systematic Reviews of Interventions (version 6.3) was used to evaluate bias [54]. Of the 23 studies, 17 (74%) [25,27,[35][36][37]40,41,[43][44][45][46][47][48][49][50]52,53,55] used a computer-generated list of random numbers to allocate individuals to the intervention or control groups, which was deemed minimal risk of bias, and 10 (43%) [26,36,37,40,[44][45][46]48,52,53] concealed the allocation of participants, which was considered high risk of bias. Given the nature of the mHealth intervention, participants and personnel were blinded in only 4 (17%) of the 23 studies [37,39,46,47,55].…”

Development and Validation of the Coronary Heart Disease Scale Among the System of Quality of Life Instruments for Chronic Diseases QLICD-CHD (V2.0) Based on Classical Test Theory and Generalizability Theory

“…Generic scales only take into account certain symptoms of chronic diseases and are unable to comprehensively assess the impact of a specific disease on an individual, while specific scales are more sensitive and precise for a particular disease or symptom, and have a higher accuracy in the assessment of QoL. The main specific scales currently applied to CHD include: Seattle Angina Questionnaire(SAQ), 12 Myocardial Infarction Dimensional Assessment Scale(MIDAS), 13 Quality of Life after Myocardial Infarction(QLMI), 14 Angina Pectoris Quality of Life Questionnaire(APQLQ), Chronic Heart Failure Questionnaire(CHQ), 15 Coronary Revascularization Outcome Questionnaire(CROQ), Cardiac Health Profile(CHP), Cardiovascular Limitations and Symptoms Profile(CLASP), etc. 16 …”