Smartphone-based Home Care and Cardiac Rehab Post MI
Smartphone-based Home Care and Cardiac Rehab Post MI
Of 835 patients assessed for eligibility, 120 consented and indicated intent to attend CR. Figure 2 illustrates participant recruitment, randomisation and waning throughout the trial. Randomisation yielded 60 participants per group. Mean age (55.7±10.4 vs 55.5±9.6 years) and gender proportion (82% vs 85% male) between groups were similar.
(Enlarge Image)
Figure 2.
Recruitment process and flow of participants through traditional cardiac rehabilitation and Care Assessment Platform-cardiac rehabilitation, intervention cardiac rehabilitation programmes.
Uptake was 1.3 times higher in CAP-CR (48/60, 80%) than in TCR (37/60, 62%) (RR 1.30; 95% CI 1.03 to 1.64; p<0.05). Adherence was 94% (45/48) in the CAP-CR group and 68% (25/37) in the TCR group. CAP-CR participants were 1.4 times more likely to adhere to the programme (RR 1.4; 95% CI 1.13 to 1.70; p<0.05). CR completion in CAP-CR (48/60) was 33% higher than TCR (28/60) (RR 1.71; 95% CI 1.30 to 2.27; p<0.05). The results of the multivariate analysis to analyse the association between the nine selected baseline characteristics and outcomes did not yield any predictor of the uptake and adherence.
More than 70% of the 44 dropouts (including non-uptake or non-completion) were from TCR. Figure 3 shows primary reasons for dropout as a percentage of total dropouts. The main TCR dropout reasons were logistical (25%) and competing life demands (14%). Although change in circumstances was a common reason for both groups (16%), this was mainly due to deterioration in health unrelated to CR (CAP-CR 14%; TCR 9%). Difficulty in using IT tools was reported by 7% (n=3 CAP-CR) of dropouts.
(Enlarge Image)
Figure 3.
Percentage of dropouts from the traditional and Care Assessment Platform-cardiac rehabilitation, intervention cardiac rehabilitation programmes per primary reported reason (n=44). Primary reasons for dropout categories and subcategories provided were competing life demands (work; family/care responsibilities and stress); logistical reasons (lack of time; inconvenient location; lack of transport; excessive paperwork involved and relocation); change in circumstances (deterioration in health and/or medical care needs unrelated to cardiac rehabilitation; no longer meeting inclusion/exclusion criteria; and difficulty using the smartphone due to vision, dexterity or other problems); study design (do not feel benefit from the intervention and administrative or clinical errors (eg, appointment time errors)); no longer interested/lack of motivation or commitment; no longer feel cardiac rehabilitation is required due to health improvement; concerns regarding privacy and other reasons.
There were no significant differences in baseline demographic and clinical characteristics of participants who commenced CR (see Table 1). Both groups had an average BMI above 25 kg/m and WC greater than 80 cm (females) and 94 cm (males), indicative of increased risk for CVD.
Table 2 shows secondary outcome measures at baseline, 6 weeks and the mean difference between these time points (95% CI and p value). Both CAP-CR and TCR participants had significant improvements in dietary intake (fat, fibre and salt), mental health (DASS-depression) and triglycerides. There were significant improvements in functional capacity, via increase in 6MWT (CAP-CR (60 m); TCR (47 m)). Although DASS-depression scores were normal for both groups at baseline, both programmes were effective in reducing it further at 6 weeks. Reduction in anxiety scores (DASS) and psychological distress (K10) was found only with CAP-CR. Slight but significant improvements in weight and WC were observed in CAP-CR participants. The HRQoL (EQ5D-Index) improved significantly in CAP-CR participants compared with TCR.
Table 3 shows the difference in means between groups in their change from baseline to 6 weeks for secondary outcomes. A difference in means of zero suggests the change from baseline to 6 weeks was the same for both groups. Results of this analysis show similar size of change for most secondary outcome measures, from baseline to 6 weeks CR, for both programmes.
Statistical significance was observed for the difference in the means in diastolic BP and EQ5D-Index for CAP-CR participants and for triglycerides in the TCR group.
Figure 4 shows the trend in mean values for 6MWT and lipid profiles, and median values for EQ-5D and K10 scores, from baseline to 6 weeks to 6 months. The improved 6MWT distance at 6 weeks was maintained at 6 months by both groups. Between-group differences for changes in 6MWT, low-density lipoprotein, high-density lipoprotein, EQ5D-Index or K10 were not significant at 6 months.
(Enlarge Image)
Figure 4.
(A) Line graphs showing changes in mean±SD for 6 Minute Walk Test, low-density lipoprotein and high-density lipoprotein over 6 months for traditional cardiac rehabilitation and Care Assessment Platform-cardiac rehabilitation, intervention cardiac rehabilitation participants. (B) Box plots of EQ5D-index (median values) and Kessler 10 scores for traditional cardiac rehabilitation and Care Assessment Platform-cardiac rehabilitation, intervention cardiac rehabilitation participants.
Smartphone-measured steps and/or exercise activities.
Daily exercise (automated step counts or manually described) entries were recorded by 89% of CAP-CR participants who adhered (n=45) to the CR programme. Questionnaire feedback showed >85% of the participants found the step counter to be motivational in reaching CR goals.
Results
Of 835 patients assessed for eligibility, 120 consented and indicated intent to attend CR. Figure 2 illustrates participant recruitment, randomisation and waning throughout the trial. Randomisation yielded 60 participants per group. Mean age (55.7±10.4 vs 55.5±9.6 years) and gender proportion (82% vs 85% male) between groups were similar.
(Enlarge Image)
Figure 2.
Recruitment process and flow of participants through traditional cardiac rehabilitation and Care Assessment Platform-cardiac rehabilitation, intervention cardiac rehabilitation programmes.
Primary Outcomes
Uptake was 1.3 times higher in CAP-CR (48/60, 80%) than in TCR (37/60, 62%) (RR 1.30; 95% CI 1.03 to 1.64; p<0.05). Adherence was 94% (45/48) in the CAP-CR group and 68% (25/37) in the TCR group. CAP-CR participants were 1.4 times more likely to adhere to the programme (RR 1.4; 95% CI 1.13 to 1.70; p<0.05). CR completion in CAP-CR (48/60) was 33% higher than TCR (28/60) (RR 1.71; 95% CI 1.30 to 2.27; p<0.05). The results of the multivariate analysis to analyse the association between the nine selected baseline characteristics and outcomes did not yield any predictor of the uptake and adherence.
More than 70% of the 44 dropouts (including non-uptake or non-completion) were from TCR. Figure 3 shows primary reasons for dropout as a percentage of total dropouts. The main TCR dropout reasons were logistical (25%) and competing life demands (14%). Although change in circumstances was a common reason for both groups (16%), this was mainly due to deterioration in health unrelated to CR (CAP-CR 14%; TCR 9%). Difficulty in using IT tools was reported by 7% (n=3 CAP-CR) of dropouts.
(Enlarge Image)
Figure 3.
Percentage of dropouts from the traditional and Care Assessment Platform-cardiac rehabilitation, intervention cardiac rehabilitation programmes per primary reported reason (n=44). Primary reasons for dropout categories and subcategories provided were competing life demands (work; family/care responsibilities and stress); logistical reasons (lack of time; inconvenient location; lack of transport; excessive paperwork involved and relocation); change in circumstances (deterioration in health and/or medical care needs unrelated to cardiac rehabilitation; no longer meeting inclusion/exclusion criteria; and difficulty using the smartphone due to vision, dexterity or other problems); study design (do not feel benefit from the intervention and administrative or clinical errors (eg, appointment time errors)); no longer interested/lack of motivation or commitment; no longer feel cardiac rehabilitation is required due to health improvement; concerns regarding privacy and other reasons.
Secondary Outcomes
There were no significant differences in baseline demographic and clinical characteristics of participants who commenced CR (see Table 1). Both groups had an average BMI above 25 kg/m and WC greater than 80 cm (females) and 94 cm (males), indicative of increased risk for CVD.
Change in Secondary Outcomes From Baseline to the End of the 6-week CR Programme
Table 2 shows secondary outcome measures at baseline, 6 weeks and the mean difference between these time points (95% CI and p value). Both CAP-CR and TCR participants had significant improvements in dietary intake (fat, fibre and salt), mental health (DASS-depression) and triglycerides. There were significant improvements in functional capacity, via increase in 6MWT (CAP-CR (60 m); TCR (47 m)). Although DASS-depression scores were normal for both groups at baseline, both programmes were effective in reducing it further at 6 weeks. Reduction in anxiety scores (DASS) and psychological distress (K10) was found only with CAP-CR. Slight but significant improvements in weight and WC were observed in CAP-CR participants. The HRQoL (EQ5D-Index) improved significantly in CAP-CR participants compared with TCR.
Table 3 shows the difference in means between groups in their change from baseline to 6 weeks for secondary outcomes. A difference in means of zero suggests the change from baseline to 6 weeks was the same for both groups. Results of this analysis show similar size of change for most secondary outcome measures, from baseline to 6 weeks CR, for both programmes.
Statistical significance was observed for the difference in the means in diastolic BP and EQ5D-Index for CAP-CR participants and for triglycerides in the TCR group.
Six-month Results
Figure 4 shows the trend in mean values for 6MWT and lipid profiles, and median values for EQ-5D and K10 scores, from baseline to 6 weeks to 6 months. The improved 6MWT distance at 6 weeks was maintained at 6 months by both groups. Between-group differences for changes in 6MWT, low-density lipoprotein, high-density lipoprotein, EQ5D-Index or K10 were not significant at 6 months.
(Enlarge Image)
Figure 4.
(A) Line graphs showing changes in mean±SD for 6 Minute Walk Test, low-density lipoprotein and high-density lipoprotein over 6 months for traditional cardiac rehabilitation and Care Assessment Platform-cardiac rehabilitation, intervention cardiac rehabilitation participants. (B) Box plots of EQ5D-index (median values) and Kessler 10 scores for traditional cardiac rehabilitation and Care Assessment Platform-cardiac rehabilitation, intervention cardiac rehabilitation participants.
Additional Analysis
Smartphone-measured steps and/or exercise activities.
Daily exercise (automated step counts or manually described) entries were recorded by 89% of CAP-CR participants who adhered (n=45) to the CR programme. Questionnaire feedback showed >85% of the participants found the step counter to be motivational in reaching CR goals.
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