Dose-Response Effect of a Digital Health Intervention During Cardiac Rehabilitation: Subanalysis of Randomized Controlled Trial

R Jay Widmer, Conor Senecal, Thomas G Allison, Francisco Lopez-Jimenez, Lilach O Lerman, Amir Lerman, R Jay Widmer, Conor Senecal, Thomas G Allison, Francisco Lopez-Jimenez, Lilach O Lerman, Amir Lerman

Abstract

Background: Previous data have validated the benefit of digital health interventions (DHIs) on weight loss in patients following acute coronary syndrome entering cardiac rehabilitation (CR).

Objective: The primary purpose of this study was to test the hypothesis that increased DHI use, as measured by individual log-ins, is associated with improved weight loss. Secondary analyses evaluated the association between log-ins and activity within the platform and exercise, dietary, and medication adherence.

Methods: We obtained DHI data including active days, total log-ins, tasks completed, educational modules reviewed, medication adherence, and nonmonetary incentive points earned in patients undergoing standard CR following acute coronary syndrome. Linear regression followed by multivariable models were used to evaluate associations between DHI log-ins and weight loss or dietary adherence.

Results: Participants (n=61) were 79% male (48/61) with mean age of 61.0 (SD 9.7) years. We found a significant positive association of total log-ins during CR with weight loss (r2=.10, P=.03). Educational modules viewed (r2=.11, P=.009) and tasks completed (r2=.10, P=.01) were positively significantly associated with weight loss, yet total log-ins were not significantly associated with differences in dietary adherence (r2=.05, P=.12) or improvements in minutes of exercise per week (r2=.03, P=.36).

Conclusions: These data extend our previous findings and demonstrate increased DHI log-ins portend improved weight loss in patients undergoing CR after acute coronary syndrome. DHI adherence can potentially be monitored and used as a tool to selectively encourage patients to adhere to secondary prevention lifestyle modifications.

Trial registration: ClinicalTrials.gov (NCT01883050); https://ichgcp.net/clinical-trials-registry/NCT01883050.

Keywords: cardiovascular prevention; digital health interventions; online; secondary prevention.

Conflict of interest statement

Conflicts of Interest: None declared.

©R Jay Widmer, Conor Senecal, Thomas G Allison, Francisco Lopez-Jimenez, Lilach O Lerman, Amir Lerman. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.02.2020.

Figures

Figure 1
Figure 1
CONSORT diagram for digital health use substudy of initial feasibility study and randomized trial.
Figure 2
Figure 2
Weight loss (kg) compared with number of log-ins during the 3-month cardiac rehabilitation period (r2=.10, P=.03).
Figure 3
Figure 3
Number of log-ins during 3 months of cardiac rehabilitation compared with (A) diet scores (r2=.05, P=.12) and (B) minutes of weekly exercise (r2=.03, P=.36).
Figure 4
Figure 4
Increased collection of Healthies, nonmonetary point-based incentives, was significantly associated with (A) improved weight loss and (B) improvements in Dartmouth Quality of Life.
Figure 5
Figure 5
Increased weight loss was associated with (A) an increased number of digital health tasks completed (r2=.10, P=.01) and (B) the number of passive educational views (r2=.11, P=.009) during 3 months of standard cardiac rehabilitation.

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