Kovell Lara C, Bothwick Victoria, McCabe Paul, Juraschek Stephen P, Meng Yuchen, Revoori Ritika, Pena Stephanie, Schoenthaler Antoinette, Adhikari Samrachana, Dodson John A
Author Affiliations: Department of Medicine, University of Massachusetts Chan Medical School, UMass Memorial Medical Center, Worcester, Massachusetts (Drs Kovell, Bothwick, and Revoori); Division of Cardiology, Department of Medicine, Saint Vincent Hospital, Worcester, Massachusetts (Dr McCabe); Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts (Dr Juraschek); Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York (Mss Meng and Pena and Dr Dodson); Institute for Excellence in Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, New York (Dr Schoenthaler); and Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York (Dr Adhikari).
J Cardiopulm Rehabil Prev. 2025 Jan 1;45(1):57-64. doi: 10.1097/HCR.0000000000000911. Epub 2024 Nov 28.
Hypertension (HTN) is common and represents a major modifiable risk factor for ischemic heart disease in older adults. While home blood pressure monitoring (HBPM) is important in HTN management, patterns of HBPM engagement in older adults undergoing mobile health cardiac rehabilitation (mHealth-CR) are unknown. We aimed to identify patterns of adherence to HBPM in a cohort of older adults undergoing mHealth-CR to optimize HBPM use in the future.
We used interim data from the ongoing Rehabilitation using Mobile Health for Older Adults with Ischemic Heart Disease in the Home Setting (RESILIENT) randomized trial, in which intervention arm participants (adults ≥ 65 years with ischemic heart disease) were instructed to monitor blood pressure (BP) at least weekly. Engagement groups were determined by latent class analysis and compared using ANOVA or Chi-Square tests. Longitudinal mixed effect modeling determined the associations between weekly HBPM and baseline covariates including uncontrolled HTN, obesity, diabetes, depression, alcohol, and tobacco use.
Of the 111 participants, the mean age was 71.9 ± 5.6 years, and 83% had HTN. Over the 12-week study, mean HBPM engagement was 2.3 ± 2.3 d/wk. We observed 3 distinct patterns of engagement: high engagement (22%), gradual decline (10%), and sustained baseline engagement (68%). HBPM adherence decreased in two of the engagement groups over time. Of the covariates tested, only depression was associated with weekly HBPM after adjusting for relevant covariates (OR 9.09, P = .03).
In this older adult cohort undergoing mHealth-CR, we found three main engagement groups with declining engagement over time in two of the three groups. These patterns can inform future mHealth-CR interventions.
高血压（HTN）很常见，是老年人缺血性心脏病的一个主要可改变风险因素。虽然家庭血压监测（HBPM）在高血压管理中很重要，但在接受移动健康心脏康复（mHealth-CR）的老年人中，HBPM的参与模式尚不清楚。我们旨在确定一组接受mHealth-CR的老年人中HBPM的依从模式，以便未来优化HBPM的使用。
我们使用了正在进行的“居家环境中使用移动健康对老年缺血性心脏病患者进行康复治疗（RESILIENT）”随机试验的中期数据，其中干预组参与者（≥65岁的缺血性心脏病成年人）被指示至少每周监测一次血压（BP）。通过潜在类别分析确定参与组，并使用方差分析或卡方检验进行比较。纵向混合效应模型确定了每周HBPM与基线协变量之间的关联，包括未控制的高血压、肥胖、糖尿病、抑郁症、酒精和烟草使用情况。
在111名参与者中，平均年龄为71.9±5.6岁，83%患有高血压。在为期12周的研究中，平均HBPM参与度为2.3±2.3天/周。我们观察到3种不同的参与模式：高参与度（22%）、逐渐下降（10%）和持续基线参与度（68%）。随着时间的推移，两个参与组的HBPM依从性下降。在测试的协变量中，调整相关协变量后，只有抑郁症与每周HBPM相关（OR 9.09，P = 0.03）。
在这个接受mHealth-CR的老年人群体中，我们发现了三个主要的参与组，其中三个组中的两个组的参与度随着时间的推移而下降。这些模式可为未来的mHealth-CR干预提供参考。
