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

Autor: Harzand A; Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA. arash.harzand@emory.edu.; Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA. arash.harzand@emory.edu., Alrohaibani A; Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA.; Department of Pathology, Oregon Health and Science University, Portland, OR, USA., Idris MY; Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA., Spence H; Aptive Resources, LLC, Alexandria, VA, USA., Parrish CG; Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA., Rout PK; Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA.; Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA., Nazar R; Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA., Davis-Watts ML; Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA., Wright PP; Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA., Vakili AA; Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA., Abdelhamid S; Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA., Vathsangam H; Movn Health, Irvine, CA, USA., Adesanya A; Movn Health, Irvine, CA, USA., Park LG; School of Nursing, University of California, San Francisco, CA, USA.; San Francisco VA Medical Center, San Francisco, CA, USA., Whooley MA; San Francisco VA Medical Center, San Francisco, CA, USA.; Department of Medicine, University of California, San Francisco, CA, USA., Wenger NK; Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA., Zafari AM; Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA.; Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA., Shah AJ; Atlanta VA Medical Center, 1670 Clairmont Road (111/CD), Decatur, GA, 30033, USA.; Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA.; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
Jazyk: angličtina
Zdroj: BMC cardiovascular disorders [BMC Cardiovasc Disord] 2023 Sep 12; Vol. 23 (1), pp. 453. Date of Electronic Publication: 2023 Sep 12.
DOI: 10.1186/s12872-023-03471-w
Abstrakt: 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).
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Databáze: MEDLINE
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