EFFECT OF A MOBILE-TECHNOLOGY DRIVEN CARDIAC REHABILITATION ON ADHERENCE AND CLINICAL OUTCOMES IN POST-MYOCARDIAL INFARCTION PATIENTS FOLLOWING PERCUTANEOUS CORONARY INTERVENTION

R. Ganesan^1,2, C. Pereira², E.C. Neoh¹, J. Chow¹, V. Hoon³, B.L. Seng⁴, H. Shannon²

¹Tan Tock Seng Hospital, Physiotherapy, Singapore, Singapore, ²University College London, Physiotherapy, London, United Kingdom, ³Tan Tock Seng Hospital, Cardiology, Singapore, Singapore, ⁴Immersive Play Pte Ltd, Singapore, Singapore

Background: Despite the multifaceted benefits of cardiac rehabilitation (CR), uptake and adherence are often low. Various barriers have been cited for poor uptake and adherence, which often focus on the inflexible timings of CR classes. Technology has the potential to overcome these barriers, yet there is limited research on the delivery of CR through this approach.

Purpose: The purpose of the study was to investigate adherence and clinical outcomes of CR, when delivered via a novel Heart-Track (HT) mobile application, as compared to traditional CR for patients after a percutaneous coronary intervention (PCI) following a myocardial infarction.

Methods: A retrospective secondary analysis of data was performed to evaluate adherence for the intervention (HT-group) and usual care (CR-group) groups by evaluating the number of sessions completed and adherence rate. Clinical outcomes such as the 6-minute walk test (6MWT), Self-Efficacy of Exercise Scale (SEE) and MacNew Quality of Life After Myocardial Infarction Questionnaire (MacNew) were evaluated pre-and post-intervention and change between groups. Adherence rate was also compared with the change in clinical outcomes between groups.

Results: Data were analysed for 34 participants (17 in each group), 30 of whom were men. There was no significant difference in adherence in terms of the number of sessions completed and adherence rate between the HT-group and CR-group (both p=0.66). However, there were markedly more sessions completed by the HT-group compared to the CR-group by the end of Week 8 (70.6% versus 58.8%). Furthermore, the adherence rate was high for both groups and above 100% for 69% and 61% of participants in the HT-group and CR-group respectively. Adherence was not related to any of the participant characteristics measured (including age, gender, and ethnicity). In terms of participant outcomes, there was a significant improvement in 6MWT distance following intervention for the HT-group (p=0.02) but not for the CR-group (p=0.26). There was no clinically important change in SEE and MacNew questionnaire for participants in either group. A weak correlation was found between adherence rate and the change in outcomes.

Conclusions: This study shows sustained adherence was achieved using HT. This provides a viable solution to overcoming the barriers to CR participation as technology enables CR sessions to be conducted, regardless of centre-based schedules. Furthermore, 6MWT distance improvements were achieved by the HT-group reflecting an impact on clinical outcomes, which were not achieved by the CR-group. However, further investigation is needed to explore HT efficacy, particularly amongst women for whom CR adherence may be a challenge, and the impact of HT on mortality.

Implications: This is the first study conducted in Singapore evaluating adherence and the impact on clinical outcomes following the use of the novel HT mobile application. Findings suggest that HT appears to be a viable alternative to CR, and may be more favourable for some patients. Considering HT as a model of CR programme delivery may help to provide a new dawn to overcome the age-old barriers posed to uptake and adherence of traditional CR programmes, thus positively impacting the physical fitness and well-being of patients post-PCI.

Funding acknowledgements:For Primary study:
Ng Teng Fong Healthcare Innovation Programme
Tan Tock Seng Hospital Innovation fund

Keywords:
Cardiac rehabilitation
Mobile technology
Myocardial infarction

Topics:
Cardiorespiratory
Community based rehabilitation
Innovative technology: information management, big data and artificial intelligence

Did this work require ethics approval? Yes

Institution: National Healthcare Group

Committee: Domain Specific Research Board (Singapore)

Ethics number: 2018/00977