Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden.
J Med Internet Res. 2022 Mar 31;24(3):e25224. doi: 10.2196/25224.
Cardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction. However, the fulfillment of guideline-recommended cardiac rehabilitation targets is unsatisfactory. eHealth offers new possibilities to improve clinical care.
This study aims to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to center-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care).
All 150 patients participated in cardiac rehabilitation. Patients randomized to the intervention group (n=101) received access to the application for 25 weeks where information about lifestyle (eg, diet and physical activity), risk factors (eg, weight and blood pressure [BP]), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was a change in submaximal exercise capacity (Watts [W]) between follow-up visits. Secondary outcomes included changes in modifiable risk factors between baseline and follow-up visits and uptake and adherence to the application. Regression analysis was used, adjusting for relevant baseline variables.
There was a nonsignificant trend toward a larger change in exercise capacity in the intervention group (n=66) compared with the usual care group (n=40; +14.4, SD 19.0 W, vs +10.3, SD 16.1 W; P=.22). Patients in the intervention group achieved significantly larger BP reduction compared with usual care patients at 2 weeks (systolic -27.7 vs -16.4 mm Hg; P=.006) and at 6 to 10 weeks (systolic -25.3 vs -16.4 mm Hg; P=.02, and diastolic -13.4 vs -9.1 mm Hg; P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs +1.4 points; P=.05), mostly owing to an increase in the consumption of fish and fruit. At 6 to 10 weeks, 64% (14/22) versus 46% (5/11) of smokers in the intervention versus usual care groups had quit smoking, and at 12 to 14 months, the respective percentages were 55% (12/22) versus 36% (4/11). However, the number of smokers in the study was low (33/149, 21.9%), and the differences were nonsignificant. Attendance in cardiac rehabilitation was high, with 96% (96/100) of patients in the intervention group and 98% (48/49) of patients receiving usual care only attending 12- to 14-month follow-up. Uptake (logging data in the application at least once) was 86.1% (87/101). Adherence (logging data at least twice weekly) was 91% (79/87) in week 1 and 56% (49/87) in week 25.
Complementing cardiac rehabilitation with a web-based application improved BP and dietary habits during the first months after myocardial infarction. A nonsignificant tendency toward better exercise capacity and higher smoking cessation rates was observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation.
ClinicalTrials.gov NCT03260582; https://clinicaltrials.gov/ct2/show/NCT03260582.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-018-3118-1.
心脏康复对于降低心肌梗死后的死亡率和发病率至关重要。然而，指南推荐的心脏康复目标的实现并不令人满意。电子健康为改善临床护理提供了新的可能性。
本研究旨在评估一种基于网络的应用程序在支持生活方式建议的依从性和危险因素的自我控制方面的效果（干预组），与仅进行心脏康复（常规护理）相比。
所有 150 名患者均接受心脏康复。随机分配到干预组（n=101）的患者可在 25 周内访问该应用程序，在该应用程序中可以登记有关生活方式（如饮食和体力活动）、危险因素（如体重和血压[BP]）和症状的信息。该软件提供反馈和生活方式建议。主要结果是随访期间亚最大运动能力（瓦特[W]）的变化。次要结果包括基线和随访期间可改变的危险因素的变化以及应用程序的使用率和依从性。使用回归分析，根据相关基线变量进行调整。
与常规护理组（n=40）相比，干预组（n=66）的运动能力变化有增加的趋势，但无统计学意义（增加 14.4，标准差 19.0 W，vs 增加 10.3，标准差 16.1 W；P=.22）。与常规护理患者相比，干预组患者在 2 周时（收缩压-27.7 与-16.4 mm Hg；P=.006）和 6 至 10 周时（收缩压-25.3 与-16.4 mm Hg；P=.02，舒张压-13.4 与-9.1 mm Hg；P=.05）血压降低更为显著。在干预组中，健康饮食指数评分在基线和 2 周随访之间显著改善（增加 2.3 与增加 1.4 分；P=.05），这主要归因于鱼类和水果的摄入量增加。在 6 至 10 周时，干预组中有 64%（14/22）的吸烟者与常规护理组中的 46%（5/11）的吸烟者戒烟，在 12 至 14 个月时，相应的百分比分别为 55%（12/22）和 36%（4/11）。然而，研究中的吸烟者人数较少（33/149，21.9%），差异无统计学意义。心脏康复的出勤率很高，干预组中有 96%（96/100）的患者和常规护理组中有 98%（48/49）的患者参加了 12 至 14 个月的随访。使用率（至少在应用程序中记录一次数据）为 86.1%（87/101）。在第 1 周时，依从性（至少每周记录两次数据）为 91%（79/87），在第 25 周时为 56%（49/87）。
心脏康复补充基于网络的应用程序可以改善心肌梗死后头几个月的血压和饮食习惯。观察到运动能力更好和戒烟率更高的趋势，但无统计学意义。尽管研究小组规模较小，但这些积极趋势支持在心脏康复中进一步开发电子健康。
ClinicalTrials.gov NCT03260582；https://clinicaltrials.gov/ct2/show/NCT03260582.
国际注册报告标识符（IRRID）：RR2-10.1186/s13063-018-3118-1.
