The Cardiac Rehabilitation Program at the Albany Veterans Administration Medical Center

Objective: To examine whether mobile technology improves adherence to cardiac rehabilitation and other outcomes. Methods: We identified enrollees of the cardiac rehabilitation program at Boston Medical Center from 2016-2020 (n=830). Some enrollees used a mobile technology application (Wellframe.com) that provided a customized interactive list of educational content in a progressive manner, used the patient’s smart phone accelerometer to provide daily step counts, and served as a two-way messaging system between the patient and the program staff. Adherence to cardiac rehabilitation was defined as the number of attended prescribed sessions and completion of the program. To evaluate change in the following: exercise capacity, Beck Depression Index (BDI) scores, weight, quality of life scores and Rate Your Plate nutrition scores, we used the generalized estimating equation method. Results: After 2:1 propensity score matching for age, sex, race, education, smoking status, transportation time to cardiac rehabilitation center, qualifying diagnosis, and baseline BDI score, there were 121 enrollees in the group using the Wellframe application as a supplement to the rehabilitation program and 280 enrollees in the Standard rehabilitation group. Enrollees had a mean age of 59 years; 32% were women, and 42% were black. Those in the mobile technology group attended a higher number of prescribed sessions (mean 28 vs. 22), RR: 1.17 (95% CI: 1.04-1.32, p=0.009), were 1.8 times more likely to complete the cardiac rehabilitation program (p=0.01), and had a slightly greater weight loss (lbs) post rehabilitation: -1.71 (95% CI: -0.30, -3.11, p=0.02) as compared to those in the Standard group; other outcomes were similar between the groups (Table 1). Conclusion: In a propensity-matched, racially diverse population, we found that adjunctive use of mobile technology significantly improved adherence to cardiac rehabilitation and number of attended sessions.

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Mobile Technology Improves Adherence to Cardiac Rehabilitation: A Propensity Score–Matched Study

Journal of the American Heart Association ◽

10.1161/jaha.120.020482 ◽

2021 ◽

Author(s):

Tasnim F. Imran ◽

Na Wang ◽

Stephanie Zombeck ◽

Gary J. Balady

Keyword(s):

Cardiac Rehabilitation ◽

Mobile Technology ◽

Smoking Status ◽

Medical Center ◽

Rehabilitation Program ◽

Standard Group ◽

Cardiac Rehabilitation Program ◽

Technology Application ◽

Technology Group ◽

Matched Study

Background Despite its established effectiveness, adherence to cardiac rehabilitation remains suboptimal. The purpose of our study is to examine whether mobile technology improves adherence to cardiac rehabilitation and other outcomes. Methods and Results We identified all enrollees of the cardiac rehabilitation program at Boston Medical Center from 2016 to 2019 (n=830). Some enrollees used a mobile technology application that provided a customized list of educational content in a progressive manner, used the patient’s smartphone accelerometer to provide daily step counts, and served as a 2‐way messaging system between the patient and program staff. Adherence to cardiac rehabilitation was defined as the number of attended sessions and completion of the program. Enrollees had a mean age of 59 years; 32% were women, and 42% were Black. Using 3:1 propensity matching for age, sex, race/ethnicity, education, smoking status, transportation time, diagnosis, and baseline depression survey score, we evaluated change in exercise capacity, weight, functional capacity, and nutrition scores. Those in the mobile technology group (n=114) attended a higher number of prescribed sessions (mean 28 versus 22; relative risk, 1.17; 95% CI, 1.04–1.32; P =0.009), were 1.8 times more likely to complete the cardiac rehabilitation program ( P =0.01), and had a slightly greater weight loss (pounds) following rehabilitation (−1.71; 95% CI, −0.30 to −3.11; P =0.02) as compared with those in the standard group (n=213); other outcomes were similar between the groups. Conclusions In a propensity‐matched, racially diverse population, we found that adjunctive use of mobile technology is significantly associated with improved adherence to cardiac rehabilitation and number of attended sessions.

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