Smartphone and social media-based cardiac rehabilitation and secondary prevention in China (SMART-CR/SP): a parallel-group, single-blind, randomised controlled trial

Tashi Dorje, MD; Gang Zhao, MD; Khandro Tso, MD; Jing Wang, MD; Yaolin Chen, MD; Lhamo Tsokey, MD; B-K Tan, PhD; Anna Scheer, BSc; Angela Jacques, MBiostat; Zhixing Li, MD; Ruochen Wang, MD; Clara K Chow, ProfPhD; Junbo Ge, ProfMD; Andrew Maiorana, PhD

The Lancet: Digital Health (Nov 2019)

Smartphone and social media-based cardiac rehabilitation and secondary prevention in China (SMART-CR/SP): a parallel-group, single-blind, randomised controlled trial

Tashi Dorje, MD,
Gang Zhao, MD,
Khandro Tso, MD,
Jing Wang, MD,
Yaolin Chen, MD,
Lhamo Tsokey, MD,
B-K Tan, PhD,
Anna Scheer, BSc,
Angela Jacques, MBiostat,
Zhixing Li, MD,
Ruochen Wang, MD,
Clara K Chow, ProfPhD,
Junbo Ge, ProfMD,
Andrew Maiorana, PhD

Affiliations

Tashi Dorje, MD: School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
Gang Zhao, MD: Department of Cardiology, Fudan University Zhongshan Hospital, Shanghai, China
Khandro Tso, MD: Internal Medicine Department, Qilian County Hospital, Qinghai, China
Jing Wang, MD: Department of Cardiology, Fudan University Zhongshan Hospital, Shanghai, China
Yaolin Chen, MD: Department of Cardiology, Fudan University Zhongshan Hospital, Shanghai, China
Lhamo Tsokey, MD: Department of Cardiology, Fudan University Zhongshan Hospital, Shanghai, China
B-K Tan, PhD: School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia; Allied Health, Armadale Kalamunda Group, East Metropolitan Health Service, Perth, WA, Australia
Anna Scheer, BSc: School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
Angela Jacques, MBiostat: School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
Zhixing Li, MD: Department of Cardiology, Fudan University Zhongshan Hospital, Shanghai, China
Ruochen Wang, MD: Department of Cardiology, Fudan University Zhongshan Hospital, Shanghai, China
Clara K Chow, ProfPhD: Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
Junbo Ge, ProfMD: Department of Cardiology, Fudan University Zhongshan Hospital, Shanghai, China; Prof Junbo Ge, Department of Cardiology, Fudan University Zhongshan Hospital, Shanghai 200032, China
Andrew Maiorana, PhD: School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia; Allied Health Department and Advanced Heart Failure and Cardiac Transplant Service Fiona Stanley Hospital, Perth, WA, Australia; Correspondence to: Dr Andrew Maiorana, School of Physiotherapy and Exercise Science, Curtin University, Perth, WA 6845, Australia

Journal volume & issue: Vol. 1, no. 7
pp. e363 – e374

Abstract

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Summary: Background: Coronary heart disease is rapidly increasing in developing countries, but access to cardiac rehabilitation and secondary prevention remains low. In this study, we aimed to assess the effectiveness of a smartphone-based cardiac rehabilitation and secondary prevention programme delivered via the social media platform WeChat (SMART-CR/SP). Methods: In this parallel-group, single-blind, randomised controlled trial, we recruited patients aged 18 years or older with coronary heart disease who had received percutaneous coronary interventions from a large tertiary hospital in Shanghai, China. Participants were randomly assigned (1:1) by block randomisation to either a 2-month intensive programme followed by a 4-month step-down phase of SMART-CR/SP or to usual care. In the SMART-CR/SP group, participants received comprehensive cardiac rehabilitation and secondary prevention via WeChat. The usual care group received standard outpatient cardiology follow-up but without formal cardiac rehabilitation and secondary prevention. Assessments were done at baseline, 2 months, 6 months, and 12 months. The primary outcome was change in functional capacity from baseline, measured by 6-min walk distance, at 2 months and 6 months. Analysis was by intention to treat. Research personnel involved in assessments were blinded to group allocation. Adverse-event analysis was based on percentage of patients who discontinued the study owing to adverse events. SMART-CR/SP programme-related safety issues were also recorded. This study was registered with the Chinese Clinical Trial Registry, number ChiCTR-INR-16009598. Findings: Between Nov 17, 2016, and March 18, 2017, 312 patients (mean age 60·5 years [SD 9·2]), of whom 58 (19%) were female and 254 (81%) were male, were recruited and subsequently randomly assigned to SMART-CR/SP (n=156) or usual care (n=156). The improvement in 6-min walk distance at 2 months was significantly greater in the SMART-CR/SP group (from 489·2 m [99·4] at baseline to 539·1 m [68·0]) than in the control group (from 485·0 m [93·5] at baseline to 517·8 m [74.6]), with an adjusted mean difference of 20·64 m (95% CI 7·50–33·77; p=0·034). This improvement was maintained at 6 months (mean 6-min walk distance 543·4 m [67·5] in the SMART-CR/SP group vs 523·5 m [60·2] in the control group), with a mean between-group difference of 22·29 m (8·19–36·38; p=0·027). No adverse events or SMART-CR/SP programme-related safety issues were reported by participants during the study. Interpretation: SMART-CR/SP was found to be a cardiac rehabilitation and secondary prevention service model with high efficacy and accessibility and to be easy to use. These results justify the implementation of similar models of care on a broader scale. Funding: Curtin University.

Published in The Lancet: Digital Health

ISSN: 2589-7500 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Medicine (General): Computer applications to medicine. Medical informatics
Website: https://www.thelancet.com/journals/landig/home

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