Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial

Abstract

Objective Cardiac rehabilitation (CR) is pivotal in preventing recurring events of myocardial infarction (MI).This study aims to investigate the effect of a smartphone-based home service delivery (Care Assessment Platform) of CR (CAP-CR) on CR use and health outcomes compared with a traditional, centrebased programme (TCR) in post-MI patients. Methods In this unblinded randomised controlled trial, post-MI patients were randomised to TCR (n=60; 55.7 ±10.4 years) and CAP-CR (n=60; 55.5±9.6 years) for a 6-week CR and 6-month self-maintenance period. CAP-CR, delivered in participants' homes, included health and exercise monitoring, motivational and educational material delivery, and weekly mentoring consultations. CAP-CR uptake, adherence and completion rates were compared with TCR using intention-to-treat analyses. Changes in clinical outcomes (modifiable lifestyle factors, biomedical risk factors and health-related quality of life) across baseline, 6 weeks and 6 months were compared within, and between, groups using linear mixed model regression. Results CAP-CR had significantly higher uptake (80% vs 62%), adherence (94% vs 68%) and completion (80% vs 47%) rates than TCR ( p<0.05). Both groups showed significant improvements in 6-minute walk test from baseline to 6 weeks (TCR: 537±86-584±99 m; CAP-CR: 510±77-570±80 m), which was maintained at 6 months. CAP-CR showed slight weight reduction (89 ±20-88±21 kg) and also demonstrated significant improvements in emotional state (K10: median (IQR) 14.6 (13.4-16.0) to 12.6 (11.5-13.8)), and quality of life (EQ5D-Index: median (IQR) 0.84 (0.8-0.9) to 0.92 (0.9-1.0)) at 6 weeks.

Narrative Review Comparing the Benefits of and Participation in Cardiac Rehabilitation in High-, Middle- and Low-Income Countries

“…A recent randomized controlled trial demonstrated that patients using smartphone-based CR had significant higher CR participation (80% vs. 62%), adherence (94% vs. 68%) and completion (80% vs. 47%) compared to patients in traditional hospitalbased CR (p<0.05) [71]. Importantly, due to the wide dissemination of mobile technology in particular, including in LMICs, these models hold the potential to dramatically improve CR participation and adherence [71,72]. Health policy makers should strive to facilitate implementation of flexible alternative CR models, through payment to healthcare providers and population-based promotion of these models.…”

“…Though mortality as an outcome needs to be examined, a recent systematic review demonstrated that multifactorial individualized telehealth CR programs are as effective as hospital-based programs in lowering CHD risk factors and improving physical function [70]. A recent randomized controlled trial demonstrated that patients using smartphone-based CR had significant higher CR participation (80% vs. 62%), adherence (94% vs. 68%) and completion (80% vs. 47%) compared to patients in traditional hospitalbased CR (p<0.05) [71]. Importantly, due to the wide dissemination of mobile technology in particular, including in LMICs, these models hold the potential to dramatically improve CR participation and adherence [71,72].…”

2016 European Guidelines on cardiovascular disease prevention in clinical practice

“…Prosty telemonitoring, obejmujący transmisję EKG przez telefon u pacjentów z CVD, jest bezpieczny i akceptowalny dla chorych oraz skutkuje poprawą wydolności fizycznej [568]. W aktualnych badaniach stosuje się również aplikacje na smartfony, które pozwalają monitorować i przesyłać treści oraz udzielać wsparcia, z poprawą w podejmowaniu, realizacji i zakończeniu rehabilitacji u młodszych chorych [569].…”

Projeto De Reabilitação Cardiovascular No Ritmo Do Samba De Uma Universidade Pública Do Estado De São Paulo

“…Apesar dos benefícios conhecidos que os programas de Reabilitação Cardiovascular trazem para os pacientes com FR ou DCV, existe uma dificuldade na adesão ao tratamento e motivação dos pacientes que impossibilita obter melhores resultado 5,6 . Neste contexto, os profissionais se sentem motivados e encorajados a buscarem novas alternativas de programas para controle de FR e tratamento para essas doenças 7,8 . Neste contexto, os programas de Reabilitação Cardiovascular que utilizam danças, têm mostrado efeitos favoráveis no aprimoramento da aptidão física e das condições cardiovasculares semelhante ao encontrado em programas tradicionais de treinamento físico 8,9 Pensando nisso, a implementação de novas modalidades de tratamento que visam promover a melhora da qualidade de vida em indivíduos que apresentem FR para DCV, bem como, auxiliem a sua permanência no mesmo, devem ser incentivadas.…”