SMARTphone and social media-based Cardiac Rehabilitation and Secondary Prevention (SMART-CR/SP) for patients with coronary heart disease in China: a randomised controlled trial protocol

Abstract

IntroductionThe burden of cardiovascular disease (CVD) is rapidly increasing in developing countries, however access to cardiac rehabilitation and secondary prevention (CR/SP) in these countries is limited. Alternative delivery models that are low-cost and easy to access are urgently needed to address this service gap. The objective of this study is to investigate whether a smartphone and social media-based (WeChat) home CR/SP programme can facilitate risk factor monitoring and modification to improve disease self-management and health outcomes in patients with coronary heart disease (CHD), after percutaneous coronary intervention (PCI) therapy.Methods and analysisWe propose a single-blind, randomised controlled trial of 300 patients post-PCI with follow-up over 12 months. The intervention group will receive a smartphone-based and WeChat-based CR/SP programme providing education and support for risk factor monitoring and modification. SMART-CR/SP incorporates core components of modern CR/SP: physical activity tracking with interactive feedback and goal setting; education modules addressing CHD understanding and self-management; remote blood pressure monitoring and strategies to improve medication adherence. Furthermore, a dedicated data portal and a CR/SP coach will facilitate individualised supervision and counselling. The control group will receive usual care but no formal CR/SP programme. The primary outcome is change in exercise capacity measured by 6 minute walk test distance. Secondary outcomes include knowledge and awareness of CHD, risk factor status, medication adherence, psychological well-being and quality of life, major cardiovascular events, re-hospitalisations and all-cause mortality. To assess the feasibility and patients’ acceptance of the intervention, a process evaluation will be performed at the conclusion of the study.Ethics and disseminationEthics approval was granted by both the Human Research Ethics Committee of Fudan University Zhongshan Hospital (HREC B2016-058) and Curtin University Human Research Ethics Office (HRE2016-0120). Results will be disseminated via peer-reviewed publications and presentations at conferences.Clinical trial registration numberChiCTR-INR-16009598; Pre-results.

Smartphone and social media-based cardiac rehabilitation and secondary prevention in China (SMART-CR/SP): a parallel-group, single-blind, randomised controlled trial

“…Full details of the study protocol have been previously published. 17 However, we summarise it herein, including two protocol deviations. Although we initially anticipated that the requirement for owning a smartphone and using WeChat would exclude many people older than 70 years, during consumer engagement before the trial it became apparent that this would not be the case, so the upper age limit was removed.…”

Treatment models of cardiac rehabilitation in patients with coronary heart disease and related factors affecting patient compliance

“…These challenges have led to the development of alternative CR models in recent years that include multifactorial individualized telemedicine, remote healthcare focusing on exercise or recovery, and community CR. Dorje et al applied an interactive CR model based on smartphones and social media in 300 patients with CHD (Dorje et al, 2018). After 12 months of intervention, they observed a sig-nificant improvement in the intervention group when compared with the conventional group in terms of 6-minute walking distance, medication adherence, mental health, and quality of life.…”

“…Moreover, it is estimated that by 2020, the number of deaths from CHD will reach 25 million worldwide (Beatty et al, 2018). CHD has a serious impact on the quality of life and mental state of the patients (Dorje et al, 2018). The incidence of depressive symptoms in patients with CHD was reported to be 77.23% (Im et al, 2018).…”

“…Dorje (Dorje et al, 2018) Walking distance, medication adherence, mental health, quality of life These models can reduce the risk factors of CHD, the difficulty due to inconvenient transportation, and the economic burden on patients.…”

Cardio-Nephrology: The need for more collaborative efforts between therapeutic clinical trials and social health sciences to preclude cardiovascular disease complications in renal patients

“…Intervention research to explore whether technology and a social media-based (WeChat) programme can facilitate risk factor monitoring and self-management has been impressive [77] to improve outcomes in patients with CHD. A systematic review and meta-analyses assess the effectiveness of app-based interventions, to promote lifestyle changes in patients with Noncommunicable Diseases (NCDs) is also striking.…”