App Does Not Improve Functional Capacity, Blood Pressure in Cardiac Rehab

A mobile app used as part of a cardiac rehabilitation program did not improve participants’ functional capacity or blood pressure, according to a retrospective cohort study published in JMIR Cardio. Nor did it increase the likelihood that participants would complete the rehab program.

Prior studies have shown the potential of mobile apps in transforming cardiac rehab, the authors wrote. However, there is a lack of published research on associations between patient interaction with cardiac rehab mobile app use and clinical outcomes.

Cardiac rehabilitation studies show reductions in mortality and hospital admissions. Even so, the treatment is highly underutilized, with disparities across gender, socioeconomic status, race, and ethnicities. It is estimated that participation is low, ranging from 19% to 34 % with strong state-by-state variations.

“New delivery strategies are needed to increase accessibility and participation in cardiac rehabilitation,” the researchers said.

With the COVID-19 pandemic, cardiac rehab programs began to implement telehealth and hybrid approaches to delivering care, including mobile apps. The present study investigators wondered if the extent of mobile app use would be associated with important cardiac rehab outcomes. Their primary objective was association between CR mobile app use and change in functional capacity from enrollment to completion, and secondary objectives included the association between mobile app use and changes in blood pressure or program completion.

To better understand the impact, they analyzed data from 149 cardiac rehab participants at a single center from May 22, 2020, to May 21, 2021. Patients could choose to attend an in-person, hybrid, or telehealth program. Participants in all programs were offered a mobile app, but use was optional. Only those who chose to download the app were included in the study cohort.  

Coronary artery disease was the main reason for program referral (71%). Other diagnoses included valvular disease (13%), heart failure (12%), or other disease (4%). The patient cohort of 107 (mean [SD] age, 62.9 [13.02; years; 84.1% were male patients) met study inclusion criteria, used the mobile app, and completed the CR program.

Patients could use the mobile app to enter clinical data, view educational materials, set medication reminders, and message cardiac rehab staff. Concomitantly, the staff could view patient logs and activities.

Investigators quantified app use by the sum of total exercise logs, vital sign logs, and education material views. Changes in clinical characteristics were calculated by subtracting enrollment values from completion values and compared using a paired t test (2-tailed).

Associations were estimated using models adjusted for age, sex, race, ethnicity, socioeconomic status by ZIP code, insurance, and primary diagnosis for cardiac rehab referral.Change in functional capacity was measured by change in the 6 Minute Walk Test.

Findings showed no association between the amount of app use and improvement in clinical outcomes. Specifically, the researchers found no significant association between: 

• Amount of app use and improvement in changes in functional capacity
• Total exercise logs and changes in functional capacity
• Total app interaction and program completion
• Total app interactions and changes in blood pressure
• Total blood pressure logs and changes in blood pressure

The investigators also noted that adding chat messages to total app interactions did not meaningfully change the adjusted association between total app interactions and functional capacity.

However, the limitations of a retrospective cohort study must be considered, researchers noted. Generalizability may be limited since the cohort enrolled and completed the program during the COVID-9 pandemic. Moreover, most of the cohort was male (84%), self-identified as White Caucasian (53%), had private insurance (70%), and lived in neighborhoods associated with high socioeconomic status (59%). Moreover, by using data collected during the routine course of health care, the investigators could not account for all potential unmeasured confounders.

The authors encouraged further research into mobile app use, particularly studies conducted with a diverse population to address existing disparities.

“There is a high interest in mobile app use for health care delivery among patients and clinicians,” they concluded. “With this interest, technologies such as mobile apps can provide flexibility, scalability of care, accessibility of information, and communication among teams and patients.”

References

Oclaman JM, Murray ML, Grandis DJ, Beatty AL. The association between mobile app use and change in functional capacity among cardiac rehabilitation participants: cohort study. JMIR Cardio. Published online May 15, 2023 doi:10.2196/44433