mHealth-CArdiac REhabilitation for INOCA

mHealth-CArdiac REhabilitation for INOCA (INOCA-CARE)

This is a multi-site phase II, 2:1 pragmatic randomized trial of 250 participants within the NYU Langone Health (NYULH) and Emory University Medical Center system to evaluate mobile health cardiac rehabilitation (mHealth-CR) in patients who meet clinical criteria for INOCA (ischemia and no obstructive coronary disease on imaging). Participants will be randomized to mHealth-CR or usual care. The study intervention takes place for 3 months which is the time period for most traditional CR programs.

The overall study goals are threefold: 1) to evaluate whether an mHealth-CR intervention that includes activity tracking, weekly counseling, and exercise documentation, improves health status (i.e., symptoms, function, and quality of life) in patients with INOCA at 3 months; 2) to evaluate effects of the mHealth-CR intervention vs. usual care on physical activity and exercise capacity, general health status, and depressive symptoms (secondary endpoints). We will also evaluate effects on primary and secondary outcomes at 6 months and 1 year; and 3) to characterize engagement and elucidate any factors that limit engagement.

Study Overview

• Status: Recruiting
• Conditions: Ischemia
• Intervention / Treatment: Behavioral: Communication with exercise therapist; Behavioral: mHealth-CR; Behavioral: Wearable activity monitoring device

• Study Type: Interventional
• Enrollment (Estimated): 250
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Harmony Reynolds, MD; Phone Number: 212-263-7751; Email: INOCA@nyulangone.org
• Study Contact Backup: Name: John Dodson, MD; Phone Number: 212-263-7751; Email: INOCA@nyulangone.org

Study Locations

• United States
  • New York
    • New York, New York, United States, 10016
      • Recruiting
      • NYU Langone Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age 18 and over
• Diagnosis of Ischemia with Non-Obstructive Coronary Arteries (INOCA) based on evidence of ischemia and/or ischemic symptoms, plus non-obstructive Coronary artery disease (CAD) on computed tomography (CT) or invasive angiography

Exclusion Criteria:

• Seattle Angina Questionnaire (SAQ) = 100
• Non-ambulatory
• Pregnant
• Moderate or severe cognitive impairment
• Unable/willing to provide consent
• Incarcerated
• Unable to use mHealth
• Severe osteoarthritis or joint replacement within 3 months
• Parkinsons disease or other movement disorders
• Regular use of walker
• Life expectancy < 12 months
• Clinical judgement concerning other safety or non-adherence issues
• Unable to read and communicate in English since the app content is currently only available in English.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: mHealth-Cardiac Rehabilitation (CR); Participants in the mHealth-CR arm will receive daily therapist-directed activity and weekly phone calls, use a mHealth-CR app to track activity, heart rate and access educational materials, and use a wearable wrist activity monitoring device (such as Fitbit or Apple Watch).	Behavioral: Communication with exercise therapist; A personalized exercise program will be designed. The assigned therapist will identify potential barriers to this plan and develop mitigation strategies. The assigned therapist will then make phone contact with participants weekly for the duration of the study. Exercise recommendations will be titrated during calls based on review of activity data.; Behavioral: mHealth-CR; mHealth-CR software (currently, from Corrie Health) will permit 1) participant data entry about exercise; 2) viewing of educational material pertinent to the condition.; Behavioral: Wearable activity monitoring device; Participants will be offered the Fitbit Charge 5. This commercially available product measures physical activity.
Active Comparator: Usual Care; Participants in usual care arm will receive standard medical care as determined by their physician. They will also use a wearable wrist activity monitoring device.	Behavioral: Wearable activity monitoring device; Participants will be offered the Fitbit Charge 5. This commercially available product measures physical activity.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Seattle Angina Questionnaire (SAQ) score	The SAQ measures disease-related health status (functional status and quality of life) and has a four-week recall period. The SAQ generates a summary score (scale 0-100, 100 = full health, 0 = worst health).	Baseline, Month 3
Change in Seattle Angina Questionnaire (SAQ) score	The SAQ measures disease-related health status (functional status and quality of life) and has a four-week recall period. The SAQ generates a summary score (scale 0-100, 100 = full health, 0 = worst health).	Baseline, Month 12
Weekly percent completion of the mHealth-CR program	Weekly engagement will be measured as the fraction of the following elements completed each week: exercise therapy-directed activities, daily entry of exercise data and rated perceived exertion (RPE); completed weekly phone call with exercise therapist; at least one communication with exercise therapist (outside weekly phone call); reviewing educational video/text (which will vary by week). Competition will be assessed as a pseudo-continuous outcome, as the score can range from 0% (0 activities completed) to 100% (all activities completed) incorporating values for each activity.	Month 3

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in step count	Step count is measured on a continuous basis and data will be obtained from the wearable activity monitoring device.	Week 1, Month 3
Change in step count	Step count is measured on a continuous basis and data will be obtained from the wearable activity monitoring device.	Week 1, Month 12
Change in European Quality of Life Questionnaire - 5 Dimensions (EQ-5D) score	The EQ-5D comprises five questions on mobility, self care, pain, usual activities, and psychological status with three possible answers for each item (1=no problem, 2=moderate problem, 3=severe problem). A summary index with a maximum score of 1 can be derived from these five dimensions by conversion with a table of scores. The maximum score of 1 indicates the best health state, by contrast with the scores of individual questions, where higher scores indicate more severe or frequent problems.	Baseline, Month 3
Change in European Quality of Life Questionnaire - 5 Dimensions (EQ-5D) score	The EQ-5D comprises five questions on mobility, self care, pain, usual activities, and psychological status with three possible answers for each item (1=no problem, 2=moderate problem, 3=severe problem). A summary index with a maximum score of 1 can be derived from these five dimensions by conversion with a table of scores. The maximum score of 1 indicates the best health state, by contrast with the scores of individual questions, where higher scores indicate more severe or frequent problems.	Baseline, Month 12
Change in visual analogue scale (VAS) score	VAS indicates the general health status (VAS; ranges from 0-100). Higher scores indicating the better health status.	Baseline, Month 3
Change in visual analogue scale (VAS) score	VAS indicates the general health status (VAS; ranges from 0-100). Higher scores indicating the better health status.	Baseline, Month 12
Change in patient Health Questionnaire - 8 Items (PHQ-8) score	The PHQ-8 is a self-reported measure of depressive symptoms composed of 8 Likert type items with a response scale ranging from 0 (Not at all) to 3 (Nearly every day), that refer to the presence of that symptom during the previous 2 weeks. The PHQ-8 final score is obtained by adding the score for each of the items, ranging from 0 to 24 (higher scores corresponding to higher levels of depression).	Baseline, Month 3
Change in patient Health Questionnaire - 8 Items (PHQ-8) score	The PHQ-8 is a self-reported measure of depressive symptoms composed of 8 Likert type items with a response scale ranging from 0 (Not at all) to 3 (Nearly every day), that refer to the presence of that symptom during the previous 2 weeks. The PHQ-8 final score is obtained by adding the score for each of the items, ranging from 0 to 24 (higher scores corresponding to higher levels of depression).	Baseline, Month 12
Change in exercise time on treadmill stress test	The treadmill stress test measures how well the participants heart works during physical activity. This test will take about 30 minutes in total, with about 10-15 minutes spent exercising.	Baseline, Month 3

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in rose Dyspnea Scale (RDS) score	The RDS is a questionnaire that assesses how much shortness of breath a patient experiences during daily activities. The scale has four items indicating whether patients experience breathlessness with different activities (scores range from 0 to 4, with higher scores indicating dyspnea with milder activities).	Baseline, Month 3
Change in rose Dyspnea Scale (RDS) score	The RDS is a questionnaire that assesses how much shortness of breath a patient experiences during daily activities. The scale has four items indicating whether patients experience breathlessness with different activities (scores range from 0 to 4, with higher scores indicating dyspnea with milder activities).	Baseline, Month 12
Change in perceived Stress Scale 4 (PSS-4) score	The PSS-4 is a self-reported questionnaire consisting of four questions designed to measure how stressful a person perceives their life to be over the past month. Scores range from 0 to 16, with higher scores indicating greater perceived stress levels.	Baseline, Month 3
Change in perceived Stress Scale 4 (PSS-4) score	The PSS-4 is a self-reported questionnaire consisting of four questions designed to measure how stressful a person perceives their life to be over the past month. Scores range from 0 to 16, with higher scores indicating greater perceived stress levels.	Baseline, Month 12
Number of cardiovascular hospitalizations	Outcome measure will be assessed through review of the electronic health record (EHR).	Month 12

Collaborators and Investigators

• Sponsor: NYU Langone Health
• Collaborators: National Heart, Lung, and Blood Institute (NHLBI)
• Investigators: Principal Investigator: Harmony Reynolds, MD, NYU Langone Health

Study record dates

Study Major Dates

• Study Start (Actual): March 21, 2025
• Primary Completion (Estimated): July 1, 2027
• Study Completion (Estimated): May 1, 2029

Study Registration Dates

• First Submitted: February 11, 2025
• First Submitted That Met QC Criteria: February 11, 2025
• First Posted (Actual): February 17, 2025

Study Record Updates

• Last Update Posted (Actual): April 23, 2026
• Last Update Submitted That Met QC Criteria: April 21, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Ischemia; INOCA; ANOCA; no obstructive coronary artery disease
• Additional Relevant MeSH Terms: Pathologic Processes; Pathological Conditions, Signs and Symptoms; Ischemia
• Other Study ID Numbers: 23-01040; 1R01HL170666-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The de-identified participant data from the final research dataset will be shared upon reasonable request beginning 9 to 36 months after publication or as required by a condition of awards or supporting agreements, provided the requesting investigator executes a data use agreement with NYU Langone Health. This instance of data sharing will also require separate IRB review as well as review from NYU Langone's Data Sharing Strategy Board (DSSB). Requests should be directed to: harmony.reynolds@nyulangone.org. The protocol and statistical analysis plan will be posted on Clinicaltrials.gov only as required by federal regulation or supporting awards and agreements.
• IPD Sharing Time Frame: Beginning 9 months and ending 36 months following article publication or as required by a condition of awards and agreements supporting the research.
• IPD Sharing Access Criteria: The investigator who proposed to use the data will be provided access upon reasonable request. Requests should be directed to harmony.reynolds@nyulangone.org. To gain access, data requestors will need to sign a data access agreement. This instance of data sharing will also require separate IRB review as well as review from NYU Langone's DSSB.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No