Mobile Technology Improves Adherence to Cardiac Rehabilitation: A Propensity Score–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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Abstract 14892: Mobile Technology Improves Adherence to Cardiac Rehabilitation: A Propensity Score-matched Study

Circulation ◽

10.1161/circ.142.suppl_3.14892 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Tasnim F Imran ◽

Na Wang ◽

Stephanie Zombeck ◽

Gary J Balady

Keyword(s):

Propensity Score ◽

Cardiac Rehabilitation ◽

Mobile Technology ◽

Smoking Status ◽

Medical Center ◽

Estimating Equation ◽

Rehabilitation Program ◽

Standard Group ◽

Cardiac Rehabilitation Program ◽

Technology Application

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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Hybrid cardiac rehabilitation program as a potential enhancer of adherence to cardiac rehabilitation in smoking patients with coronary heart disease - a retrospective single-centre analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.347 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

M Cabral ◽

R Santos ◽

F Januario ◽

A Antunes ◽

R Fonseca-Pinto

Keyword(s):

Mental Health ◽

Cardiac Rehabilitation ◽

Smoking Status ◽

Rehabilitation Program ◽

Anxiety And Depression ◽

Cardiac Rehabilitation Program ◽

Phase 2 ◽

Significant Difference ◽

Group 2 ◽

Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Cardiac rehabilitation (CR) has well known beneficial effects on physical capacity, health-related quality of life, morbidity and mortality following an acute cardiac event. It is also known that smoking status is a powerful predictor of recurrent cardiovascular disease events. However, it has been noted that smoker patients may be less likely to access or complete CR. The aim of this study was to determine the levels of anxiety and depression and its improvement, depending on the smoking status of patients with coronary artery disease (CAD) on phase 2 of the Cardiac Rehabilitation Program (CRP). Additionally, we intend to investigate the mental health impact on smoker patients" group in conventional CR versus telemonitored CR. A retrospective study was conducted and patients in CRP between 2017 and 2020 were included. Patient selection and information collection were obtained through medical records. The outcomes of anxiety and depression were evaluated through the Hospital Anxiety and Depression Scale (HADS). Patients were divided into two groups: group 1 for non-smokers or ex-smokers and group 2 for smokers. For group 2 patients, a sub-analysis was performed for patients following the conventional CR versus the telemonitored CR, with the use of MOVIDA mobile application. Variables were analysed in the beginning (T0) and in the end (T1) of phase 2, around 3 months after. Group comparisons tests and statistical analysis were performed using SPSS software v25.0. A p-value less than 0.05 is statistically significant. We analysed 107 patients, which 93 of these were assiduous and 69 concluded the phase 2 of CRP: 39 patients in group 1 and 30 patients in group 2. Two groups have similar baseline characteristics, except for the higher presence of diabetes (p = 0.02) in group 1. It was noted an improvement in both anxiety and depression items for group 1 (p < 0.01 for both), but only for anxiety item for group 2 (p = 0.03). In subgroup analysis, we observed no improvement for smoking patients following the conventional CR for both anxiety and depression items (p = 0.60 and p = 0.71, respectably) versus a significant difference in telemonitored CR patients (p = 0.02 and p = 0.04). We hypothesise that, when compared to conventional CR, cardiac telemonitored exercise using modern communication methods may result in an improved mental health state among smoking patients, which can lead to a better adherence for CRP. Further studies including more patients and phase 3 of CRP are needed to confirm these results.

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