BMC Cardiovascular Disorders (Sep 2023)

Effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the Smart HEART clinical trial

  • Arash Harzand,
  • Alaaeddin Alrohaibani,
  • Muhammed Y. Idris,
  • Hayden Spence,
  • Cate G. Parrish,
  • Pratik K. Rout,
  • Rene Nazar,
  • Michelle L. Davis-Watts,
  • Phyllis P. Wright,
  • Alexander A. Vakili,
  • Smah Abdelhamid,
  • Harshvardhan Vathsangam,
  • Adelanwa Adesanya,
  • Linda G. Park,
  • Mary A. Whooley,
  • Nanette K. Wenger,
  • A. Maziar Zafari,
  • Amit J. Shah

DOI
https://doi.org/10.1186/s12872-023-03471-w
Journal volume & issue
Vol. 23, no. 1
pp. 1 – 8

Abstract

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Abstract Background Cardiac rehabilitation (CR) improves outcomes in heart disease yet remains vastly underutilized. Remote CR enhanced with a digital health intervention (DHI) may offer higher access and improved patient-centered outcomes over non-technology approaches. We sought to pragmatically determine whether offering a DHI improves CR access, cardiac risk profile, and patient-reported outcome measures. Methods Adults referred to CR at a tertiary VA medical center between October 2017 and December 2021 were offered enrollment into a DHI alongside other CR modalities using shared decision-making. The DHI consisted of remote CR with a structured, 3-month home exercise program enhanced with multi-component coaching, a commercial smartphone app, and wearable activity tracker. We measured completion rates among DHI participants and evaluated changes in 6-min walk distance, cardiovascular risk factors, and patient-reported outcomes from pre- to post-intervention. Results Among 1,643 patients referred to CR, 258 (16%) consented to the DHI where the mean age was 60 ± 9 years, 93% were male, and 48% were black. A majority (90%) of the DHI group completed the program. Over 3-months, significant improvements were seen in 6MWT (mean difference [MD] -29 m; 95% CI, 10 to 49; P < 0.01) and low-density lipoprotein cholesterol (MD -11 mg/dL; 95% CI, -17 to -5; P < 0.01), and the absolute proportion of patients who reported smoking decreased (10% vs 15%; MD, -5%; 95% CI, -8% to -2%; P < 0.01) among DHI participants with available data. No adverse events were reported. Conclusions The addition of a DHI-enhanced remote CR program was delivered in 16% of referred veterans and associated with improved CR access, markers of cardiovascular risk, and healthy behaviors in this real-world study. These findings support the continued implementation of DHIs for remote CR in real-world clinical settings. Trial registration This trial was registered on ClinicalTrials.gov: NCT02791685 (07/06/2016).

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