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A lifestyle and self-care focused smartphone application can improve risk factor outcomes in cardiac rehabilitation for patients after myocardial infarction

Session Poster Session 1

Speaker Halldora Ogmundsdottir Michelsen

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2019

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Poster Session

Authors : I Sjolin (Malmo,SE), H Ogmundsdottir Michelsen (Malmo,SE), M Back (Linkoping,SE), T Tanha (Malmo,SE), M Gonzalez (Brisbane,AU), C Sandberg (Umea,SE), A Olsson (Malmo,SE), A Schiopu (Malmo,SE), M Leosdottir (Malmo,SE)

I Sjolin1 , H Ogmundsdottir Michelsen1 , M Back2 , T Tanha1 , M Gonzalez3 , C Sandberg4 , A Olsson1 , A Schiopu1 , M Leosdottir1 , 1Skane University Hospital, Department of Cardiology and Department of Clinical Sciences, Lund University - Malmo - Sweden , 2Linkoping University, Department of Medical and Health Sciences, Division of Physiotherapy - Linkoping - Sweden , 3Commonwealth Scientific Research and Industrial Organization - Brisbane - Australia , 4Umea University, Heart centre and Department of Public Health and Clinical Medicine, Cardiology - Umea - Sweden ,


Background: The fulfilment of guideline recommended cardiac rehabilitation (CR) targets in patients after acute myocardial infarction (AMI) is currently unsatisfactory. eHealth i.e. the use of electronic communication in healthcare, offers a new array of possibilities to provide clinical care and improve outcomes. 
Purpose: To assess the efficacy of a web-based smartphone application designed to support adherence to lifestyle advice and self-control of risk factors, as a complement to traditional CR for improving risk factor outcomes, self-rated health and aerobic capacity in patients after AMI.  
Methods: In this multi-centre randomized controlled trial, we included 150 patients with AMI (81% men, 60.4 ±8.8 years) who subsequently participated in CR. Additionally, patients randomized to the intervention group received access to the web-based smartphone application. Changes (delta) in dietary and smoking habits, self-rated health, weight, blood pressure (BP) and lipid profile between baseline, 2-weeks and 2-months follow-up were assessed on an intention-to-treat basis using linear and logistic regression analysis adjusted for age, sex and baseline risk factors. Additionally, changes in self-rated physical activity and submaximal aerobic capacity (W) on a bicycle ergometer test, as a measure of fitness, between 2-weeks and 6-months follow-up were assessed. 
Results: Patients randomized to the intervention group achieved a larger reduction in BP than patients in the control group at 2-weeks (systolic BP -28 ±27 vs -16 ±24 mmHg, p=0.01) and 2-months follow-up (systolic BP -25 ±27 vs -16 ±27 mmHg, p=0.02; diastolic BP -13 ±16 vs -9 ±13 mmHg, p=0.046). Patients in the intervention group who smoked at baseline were significantly more often abstinent from smoking at 2-months follow-up, compared to smoking patients in the control group (76% vs 36%, p=0.03). While patients in the intervention group consumed significantly more fish and fruit at 2-weeks follow-up, there was no difference between the groups at two months post-AMI (Figure 1). There was no difference between the intervention and control groups in delta values for lipid levels, weight, self-rated health or self-rated physical activity. Both groups increased their submaximal aerobic capacity between 2-weeks and 6-months follow-up (intervention 13.6 ±19.9 W vs control 10.3 ±16.1 W, p=0.4). 
Conclusion: Complementing traditional CR with a web-based smartphone application supporting adherence to lifestyle advice and self-control of risk factors has the potential to improve blood pressure and tobacco abstinence after an AMI.

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