Feasibility of a Smartphone-enabled Cardiac Rehabilitation Program in Male Veterans With Previous Clinical Evidence of Coronary Heart Disease

Abstract

Cardiac rehabilitation (CR) is recommended for patients with coronary heart disease, however, participation among veterans remains poor. Smartphones may facilitate data transfer and communication between patients and providers, among other benefits. We evaluated the feasibility of a smartphone-enabled CR program in a population of veterans. Qualifying veterans were prospectively enrolled in a single-arm, nonrandomized feasibility study of a smartphone-enabled, home-based CR program, featuring an app with daily reminders to exercise, log vitals, and review educational materials. A coach remotely monitored patients through an online dashboard and scheduled telephone visits. Clinical end points were assessed as an exploratory aim. After 21 veterans provided informed consent, 18 were enrolled and successfully completed at least 30days of the program; 13 completed the entire 12-week intervention. Mean (standard deviation) age was 62 (7) years and 96% were male. Program completers logged a mean (standard deviation) of 3.5 (1.4) exercise sessions and 150 (86) exercise minutes per week. The majority (84%) of program completers reported being satisfied overall with the program. Mean functional capacity improved by 1.0 metabolic equivalents (5.3 to 6.3, 95% confidence interval 0.3 to 1.7; p = 0.008) and mean systolic blood pressure at rest improved by 9.6mm Hg (mean difference 9.6, 95% confidence interval -19.0 to -0.7; p = 0.049) among completers. Smartphone-enabled, home-based CR is feasible in veterans with heart disease and is associated with moderate to high levels of engagement and patient satisfaction.

Trial registration: ClinicalTrials.gov NCT02791685.

Conflict of interest statement

DISCLOSURES

Dr. Harzand reports the following activities with Moving Analytics: science advisory board, speaker’s bureau (modest), and shareholder (modest, non-fiduciary). None of the remaining authors report any potential conflicts of interest.

Copyright © 2018. Published by Elsevier Inc.

Figures

Figure 1.

Smartphone-Enabled Platform with screenshots of (A) smartphone app with daily reminders for exercise, logging vitals and taking medications; (B) smartphone app 2-way messaging; and (C) online dashboard.

Figure 2.

Mean change in METS achieved during ETT, at baseline and at 12 weeks; (MD 1, 95% CI, 0.3 to 1.7; P=0.008). Box plots show data for the cohort as a whole (N=13). Line plots show changes for individual participants. METS = metabolic equivalents; ETT = exercise treadmill testing

Figure 3.

Changes in resting vital signs at baseline and at 12 weeks for those that completed the intervention (n=16) with (A) mean change in resting HR (0 BPM, 95% CI, −5.4 to 3.7); (B) mean change in resting SBP (MD 9.6, 95% CI −19.0 to −0.7; P=0.049); and (C) mean change in resting DBP (MD 4.3; 95% CI, −12.2 to 3.6; P=0.256). HR = heart rate; BPM = beats per minute; SBP = systolic blood pressure; DBP = diastolic blood pressure