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

• Type of Material: Article
• Authors: Arash Harzand, Emory University; Alaaeddin Alrohaibani, Emory University; Muhammed Y. Idris, Morehouse School of Medicine; Hayden Spence, Aptive Resources; Cate G. Parrish, Emory Unviersity; Pratik Rout, Emory University; Rene Nazar, Atlanta VA Medical Center; Michelle L. Davis_Watts, Atlanta VA Medical Center; Phyllis P. Wright, Atlanta VA Medical Center; Alexander Vakili, Emory University; Smah Abdelhamid, Atlanta VA Medical Center; Harshvardhan Vathsangam, Movn Health; Adelanwa Adesanya, Movn Health; Linda G. Park, University of California, San Francisco; Mary A. Whooley, University of California, San Francisco; Nanette Kass Wenger, Emory University; Abarmard/Maziar Zafari, Emory University; Amit Shah, Emory University
• Language: English
• Date: 2023-09-12
• Publisher: Springer Nature
• Publication Version: Final Published Version
• Copyright Statement: © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1186%2Fs12872-023-03471-w
• Title of Journal or Parent Work: BMC Cardiovascular Disorders
• Volume: 23
• Start Page: 453
• Grant/Funding Information: VA Health Services Research & Development (Virtual CORE)/VA Office of Connected Care – AJS. 4. IP1 HX002002 from VA Health Services Research & Development Quality Enhancement Research Initiative - MAW; VA Office of Health Innovation and Learning – AJS.; VA Office of Rural Health – AJS.
• Keywords: digital technology; cardiac rehabilitation; exercise therapy patient-centered care; pragmatic clinical trial
• Research Categories: Health Sciences, Rehabilitation and Therapy

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.