Impact of Cardiac Rehabilitation on Mortality and Cardiovascular Events After Percutaneous Coronary Intervention in the Community Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial Effect of cardiac rehabilitation referral strategies on utilization rates: a prospective, controlled study. Medium-Term Effectiveness of a Comprehensive Internet-Based and Patient-Specific Telerehabilitation Program With Text Messaging Support for Cardiac Patients: Randomized Controlled Trial Internet-based training of coronary artery patients: the Heart Cycle Trial Digital health intervention during cardiac rehabilitation: A randomized controlled trial Evaluation of an mHealth-Based Adjunct to Outpatient Cardiac Rehabilitation Feasibility of a Smartphone-enabled Cardiac Rehabilitation Program in Male Veterans With Previous Clinical Evidence of Coronary Heart Disease. An m-Health system for education and motivation in cardiac rehabilitation: the experience of HeartCycle guided exercise
Background — Although numerous studies have reported that cardiac rehabilitation ( CR ) is associated with reduced mortality after myocardial infa rct ion , less is known about its association with mortality after percutaneous coronary intervention . Methods and Results — We performed a retrospective analysis of data from a prospect ively collected registry of 2395 consecutive patients who underwent percutaneous coronary intervention in Olmsted County , Minnesota , from 1994 to 2008 . The association of CR with all-cause mortality , cardiac mortality , myocardial infa rct ion , or revascularization was assessed with 3 statistical techniques : propensity score – matched analysis ( n=1438 ) , propensity score stratification ( n=2351 ) , and regression adjustment with propensity score in a 3-month l and mark analysis ( n=2009 ) . During a median follow-up of 6.3 years , 503 deaths ( 199 cardiac ) , 394 myocardial infa rct ions , and 755 revascularization procedures occurred in the study subjects . Participation in CR , noted in 40 % ( 964 of 2395 ) of the cohort , was associated with a significant decrease in all-cause mortality by all 3 statistical techniques ( hazard ratio , 0.53 to 0.55 ; P<0.001 ) . A trend toward decreased cardiac mortality was also observed in CR participants ; however , no effect was observed for subsequent myocardial infa rct ion or revascularization . The association between CR participation and reduced mortality rates was similar for men and women , for older and younger patients , and for patients undergoing elective or nonelective percutaneous coronary intervention . Conclusions — We found that CR participation after percutaneous coronary intervention was associated with a significant reduction in mortality rates . These findings add support to published clinical practice guidelines , performance measures , and insurance coverage policies that recommend CR for patients after percutaneous coronary intervention Objective Cardiac rehabilitation ( CR ) is pivotal in preventing recurring events of myocardial infa rct ion ( 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 , centre-based programme ( TCR ) in post-MI patients . Methods In this unblinded r and omised controlled trial , post-MI patients were r and omised 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 . Conclusions This smartphone-based home care CR programme improved post-MI CR uptake , adherence and completion . The home-based CR programme was as effective in improving physiological and psychological health outcomes  as traditional CR . CAP-CR is a viable option towards optimising use of CR services . Trial registration number ANZCTR12609000251224 BACKGROUND Although cardiac rehabilitation  ( CR ) has been shown to reduce mortality and is a recommended component in clinical practice guidelines , CR referral and utilization rates remain low . Referral strategies have been implemented to increase CR use but have yet to be compared concurrently . To determine the optimal strategy to maximize CR referral , enrollment , and participation , we evaluated 3 referral strategies compared with usual care : " automatic " only via discharge order or electronic record , health care provider liaison only , or a combined approach . METHODS In this prospect i ve controlled study , 2635 in patients with coronary artery disease from 11 Ontario , Canada , hospitals using 1 of the 4 referral strategies completed a sociodemographic survey , and clinical data were extracted from medical charts . One year later , 1809 participants completed a mailed survey  that assessed  CR utilization . Referral strategies were compared using generalized estimating equations to control for effect of hospital . RESULTS Adjusted analyses revealed referral strategy was significantly related to CR referral and enrollment ( P<.001 ) . Combined automatic and liaison referral result ed in the greatest CR use ( odds ratio [ OR ] , 8.41 ; 85.8 % referral , 73.5 % enrollment ) , followed by automatic only ( OR , 3.27 ; 70.2 % referral , 60.0 % enrollment ) , and liaison only ( OR , 3.35 ; 59.0 % referral , 50.6 % enrollment ) , compared with usual referral ( 32.2 % referral , 29.0 % enrollment ) . The degree of CR participation did not differ by referral strategy among referred participants ( mean [ SD ] percentage of classes attended , 82.87 % [ 27.20 % ] ; P=.88 ) . CONCLUSIONS Automatic referral combined with a patient discussion can achieve among the highest rates of CR referral reported . Wider adoption of such strategies could ensure that 45 % more patients being treated for cardiac disease would have access to and realize the benefits of CR Background Cardiac telerehabilitation has been introduced as an adjunct or alternative to conventional center-based cardiac rehabilitation to increase its long-term effectiveness . However , before large-scale implementation and reimbursement in current health care systems is possible , well- design ed studies on the effectiveness of this new additional treatment strategy are needed . Objective The aim of this trial was to assess the medium-term effectiveness of an Internet-based , comprehensive , and patient-tailored telerehabilitation program with short message service ( SMS ) texting support for cardiac patients . Methods This multicenter r and omized controlled trial consisted of 140 cardiac rehabilitation patients r and omized ( 1:1 ) to a 24-week telerehabilitation program in combination with conventional cardiac rehabilitation ( intervention group ; n=70 ) or to conventional cardiac rehabilitation alone ( control group ; n=70 ) . In the telerehabilitation program , initiated 6 weeks after the start of ambulatory rehabilitation , patients were stimulated to increase physical activity levels . Based on registered activity data , they received semiautomatic telecoaching via email and SMS text message encouraging them to gradually achieve predefined exercise training goals . Patient-specific dietary and /or smoking cessation advice was also provided as part of the telecoaching . The primary endpoint was peak aerobic capacity ( VO2 peak ) . Secondary endpoints included accelerometer-recorded daily step counts , self-assessed physical activities by International Physical Activity Question naire ( IPAQ ) , and health-related quality of life ( HRQL ) assessed by the HeartQol question naire at baseline and at 6 and 24 weeks . Results Mean VO2 peak increased significantly in intervention group patients ( n=69 ) from baseline ( mean 22.46 , SD 0.78 mL/[min*kg ] ) to 24 weeks ( mean 24.46 , SD 1.00 mL/[min*kg ] , P<.01 ) versus control group patients ( n=70 ) , who did not change significantly ( baseline : mean 22.72 , SD 0.74 mL/[min*kg ] ; 24 weeks : mean 22.15 , SD 0.77 mL/[min*kg ] , P=.09 ) . Between-group analysis of aerobic capacity confirmed a significant difference between the intervention group and control group in favor of the intervention group ( P<.001 ) . At 24 weeks , self-reported physical activity improved more in the intervention group compared to the control group ( P=.01 ) as did the global HRQL score ( P=.01 ) . Conclusions This study showed that an additional 6-month patient-specific , comprehensive telerehabilitation program can lead to a bigger improvement in both physical fitness ( VO2 peak ) and associated HRQL compared to center-based cardiac rehabilitation alone . These results are supportive in view of possible future implementation in st and ard cardiac care Low adherence to cardiac rehabilitation ( CR ) might be improved by remote monitoring systems that can be used to motivate and supervise patients and tailor CR safely and effectively to their needs . The main objective of this study was to evaluate the feasibility of a smartphone-guided training system ( GEX ) and whether it could improve exercise capacity compared to CR delivered by conventional methods for patients with coronary artery disease ( CAD ) . A prospect i ve , r and omized , international , multi-center study comparing CR delivered by conventional means ( CG ) or by remote monitoring ( IG ) using a new training steering/feedback tool ( GEx System ) . This consisted of a sensor monitoring breathing rate and the electrocardiogram that transmitted information on training intensity , arrhythmias and adherence to training prescriptions  , wirelessly via the internet , to a medical team that provided feedback and adjusted training prescriptions . Exercise capacity was evaluated prior to and 6 months after intervention . 118 patients ( 58 ± 10 years , 105 men ) with CAD referred for CR were r and omized ( IG : n = 55 , CG : n = 63 ) . However , 15 patients ( 27 % ) in the IG and 18 ( 29 % ) in the CG withdrew participation and technical problems prevented a further 21 patients ( 38 % ) in the IG from participating . No training-related complications occurred . For those who completed the study , peak VO2 improved more ( p = 0.005 ) in the IG ( 1.76 ± 4.1 ml/min/kg ) compared to CG ( −0.4 ± 2.7 ml/min/kg ) . A newly design ed system for home-based CR appears feasible , safe and improves exercise capacity compared to national CR . Technical problems reflected the complexity of applying remote monitoring solutions at an international level Background Digital health interventions ( DHI ) have been shown to improve intermediates of cardiovascular health , but their impact on cardiovascular ( CV ) outcomes has not been fully explored . The aim of this study was to determine whether DHI administered during cardiac rehabilitation ( CR ) would reduce CV‐related emergency department ( ED ) visits and rehospitalizations in patients after percutaneous coronary intervention ( PCI ) for acute coronary syndrome ( ACS ) . Methods We r and omized patients undergoing CR following ACS and PCI to st and ard CR ( n = 40 ) or CR + DHI ( n = 40 ) for 3 months with 3 patients withdrawing from CR prior to initiation in the treatment arm and 6 in the control group . The DHI incorporated an online and smartphone‐based CR platform asking the patients to report of dietary and exercise habits throughout CR as well as educational information toward patients ' healthy lifestyles . We obtained data regarding ED visits and rehospitalizations at 180 days , as well as other metrics of secondary CV prevention at baseline and 90 days . Results Baseline demographics were similar between the groups . The DHI + CR group had improved weight loss compared to the control group ( −5.1 ± 6.5 kg vs. −0.8 ± 3.8 kg , respectively , P = .02 ) . Those in the DHI + CR group also showed a non‐significant reduction in CV‐related rehospitalizations plus ED visits compared to the control group at 180 days ( 8.1 % vs 26.6 % ; RR 0.30 , 95 % CI 0.08‐1.10 , P = .054 ) . Conclusions The current study demonstrated that complementary DHI  significantly improves weight loss , and might offer a method to reduce CV‐related ED visits plus rehospitalizations in patients after ACS undergoing CR . The study suggests a role for DHI as an adjunct to CR to improve secondary prevention of CV disease . Trial registration This trial is registered at clinical trials.gov ( NCT01883050 ) A pilot study was conducted to determine if a smartphone-based adjunct to st and ard care could increase the completion rate of a cardiac rehabilitation program ( CRP ) . Based on historical completion rates , 66 participants who were about to commence a hospital-based CRP were r and omized so that half received three devices embedded with near-field communication , namely , a smartphone [ pre-installed with an application ( app ) design ed specifically for cardiac rehabilitation ] , portable blood pressure monitor , and weight scale while completing the CRP . The completion rate among participants who were r and omized to the intervention group was 88 % , compared to 67 % in the control group ( < inline-formula><tex-math notation="LaTeX">${p}$</tex-math></inline-formula > = 0.038 ) . This combined with the week-to-week frequency with which participants in the intervention group measured their blood pressure ( < inline-formula><tex-math notation="LaTeX">$\times$</tex-math></inline-formula > 5/week ) demonstrated the ability of the intervention to increase the proportion of patients who completed the CRP . No significant differences were found between the treatment groups for the measurements taken at baseline and prior to discharge from the CRP . A statistically significant correlation ( < inline-formula><tex-math notation="LaTeX">${r}$</tex-math></inline-formula > = 0.472 ; < inline-formula><tex-math notation="LaTeX">${p}$</tex-math></inline-formula > = 0.013 ) was found between the average time participants walked each day ( as estimated via the smartphone app ) and participants ’ six minute walking distance ( 6MWD ) before they were discharged from the CRP ( a clinical ly vali date d measurement ) Cardiac rehabilitation ( CR ) is recommended for patients with coronary heart disease , however , participation among veterans remains poor . Smartphones may facilitate data transfer and communication between patients and providers , among other benefits . We evaluated the feasibility of a smartphone-enabled CR program in a population of veterans . Qualifying veterans were prospect ively enrolled in a single-arm , nonr and omized feasibility study of a smartphone-enabled , home-based CR program , featuring an app with daily reminders to exercise , log vitals , and review educational material s. A coach remotely monitored patients through an online dashboard and scheduled telephone visits . Clinical end points were assessed as an exploratory aim . After 21 veterans provided informed consent , 18 were enrolled and successfully completed at least 30days of the program ; 13 completed the entire 12-week intervention . Mean ( st and ard deviation ) age was 62 ( 7 ) years and 96 % were male . Program completers logged a mean ( st and ard deviation ) of 3.5 ( 1.4 ) exercise sessions and 150 ( 86 ) exercise minutes per week . The majority ( 84 % ) of program completers reported being satisfied overall with the program . Mean functional capacity improved by 1.0 metabolic equivalents ( 5.3 to 6.3 , 95 % confidence interval 0.3 to 1.7 ; p = 0.008 ) and mean systolic blood pressure at rest improved by 9.6 mm Hg ( mean difference 9.6 , 95 % confidence interval -19.0 to -0.7 ; p = 0.049 ) among completers . Smartphone-enabled , home-based CR is feasible in veterans with heart disease and is associated with moderate to high levels of engagement and patient satisfaction Introduction Home-based programmes for cardiac rehabilitation play a key role in the recovery of patients with coronary artery disease . However , their necessary educational and motivational components have been rarely implemented with the help of modern mobile technologies . We developed a mobile health system design ed for motivating patients to adhere to their rehabilitation programme by providing exercise monitoring , guidance , motivational feedback , and educational content . Methods Our multi-disciplinary approach is based on mapping “ desired behaviours ” into specific system ’s specifications , borrowing concepts from Fogg ’s Persuasive Systems Design principles . A r and omised controlled trial was conducted to compare  mobile-based rehabilitation ( 55 patients ) versus st and ard care ( 63 patients ) . Results Some technical issues related to connectivity , usability and exercise sessions interrupted by safety algorithms affected the trial . For those who completed the rehabilitation ( 19 of 55 ) , results show high levels of both user acceptance and perceived usefulness . Adherence in terms of started exercise sessions was high , but not in terms of total time of performed exercise or drop-outs . Educational level about heart-related health improved more in the intervention group than the control . Exercise habits at 6 months follow-up also improved , although without statistical significance . Discussion Results indicate that the adopted design methodology is promising for creating applications that help improve education and foster better exercise habits , but further studies would be needed to confirm these indications
Background Despite of the established effectiveness , the acceptance and adherence of cardiac rehabilitation ( CR ) remains sub-optimal .
Mobile technologies are increasingly used in promoting CR without any firm evidence of their safety and efficacy .
This systematic review and meta- analysis were aim ed to assess the effect of mobile applications as an intervention for improving adherence to CR .