Smartphones in the secondary prevention of cardiovascular disease: a systematic review

Abstract

BackgroundCardiac Rehabilitation (CR) and secondary prevention are effective components of evidence-based management for cardiac patients, resulting in improved clinical and behavioural outcomes. Mobile health (mHealth) is a rapidly growing health delivery method that has the potential to enhance CR and heart failure management. We undertook a systematic review to assess the evidence around mHealth interventions for CR and heart failure management for service and patient outcomes, cost effectiveness with a view to how mHealth could be utilized for rural, remote and Indigenous cardiac patients.MethodsA comprehensive search of databases using key terms was conducted for the years 2000 to August 2016 to identify randomised and non-randomised trials utilizing smartphone functionality and a model of care that included CR and heart failure management. Included studies were assessed for quality and risk of bias and data extraction was undertaken by two independent reviewers.ResultsNine studies described a mix of mHealth interventions for CR (5 studies) and heart failure (4 studies) in the following categories: feasibility, utility and uptake studies; and randomised controlled trials. Studies showed that mHealth delivery for CR and heart failure management is feasible with high rates of participant engagement, acceptance, usage, and adherence. Moreover, mHealth delivery of CR was as effective as traditional centre-based CR (TCR) with significant improvement in quality of life. Hospital utilization for heart failure patients showed inconsistent reductions. There was limited inclusion of rural participants.ConclusionMobile health delivery has the potential to improve access to CR and heart failure management for patients unable to attend TCR programs. Feasibility testing of culturally appropriate mHealth delivery for CR and heart failure management is required in rural and remote settings with subsequent implementation and evaluation into local health care services.Electronic supplementary materialThe online version of this article (10.1186/s12872-018-0764-x) contains supplementary material, which is available to authorized users.

Effect of eHealth cardiac rehabilitation on health outcomes of coronary heart disease patients: A systematic review and meta‐analysis

“…The different results as identified in this review may be due to coordinated and multifaceted nature of CR compared with secondary prevention interventions (Leon et al, 2005) and the increasing maturity of eHealth intervention design and delivery. The increasing popularity of ICT may also increase the uptake of activities delivered through eHealth model (Hamilton et al, 2018).…”

“…By conducting synthesis without meta-analysis (SWiM) approach, the smartphone-based interventions have high rate of participant engagement, acceptance and adherence (Hamilton et al, 2018). For the Internet-based intervention, meta-analysis indicated no significant effects on mortality and clinical parameters including BP, cholesterol and body weight (Devi et al, 2015).…”

“…Nevertheless, the less favourable outcomes K E Y W O R D S cardiac rehabilitation, coronary heart disease, eHealth, meta-analysis, nursing, systematic review reported by these two reviews may be because secondary prevention was a broader term than CR. Most studies included in these reviews examined interventions for lifestyle management, medication adherence and/or cardiovascular risk factor reduction rather than the entire CR programme (Devi et al, 2015;Hamilton et al, 2018). There is only one SWiM focused on studies on eHealth CR conducted at a period when eHealth CR was underdeveloped and infrequent (Munro, Angus, & Leslie, 2013).…”

What do our patients expect of mobile health?

“…2,3 Another step forward in patient care is the use of mobile computing technologies and smartphone apps which aim to further simplify patient-device interaction and enhance patient-centred care. 4 RM and m-Health implementation has been evaluated in patients with pacemakers, 5 atrial fibrillation 6 and cardiac rehabilitation, 7 with patients' engagement and acceptance assessed only in the setting of cardiac rehabilitation.…”

Avaliação Econômica de um Serviço de Telemedicina para ampliação da Atenção Primária à Saúde no Rio Grande do Sul: o microcusteio do Projeto TeleOftalmo

“…Most telemedicine services that focus on diagnosis and clinical management are already routinely supplied in more developed countries. In this context, recent publications treat these services as effective in the management of patients with chronic diseases 8 , such as, for example, ECG reports 9 , screening for diabetic retinopathy 10,11 and glaucoma 12 , patient guidance through mobile apps 13 and cardiac rehabilitation 14 .…”