An internet-based cardiac rehabilitation intervention for patients with coronary artery disease: a pilot feasibility analysis

Type of funding sources: Public Institution(s). Main funding source(s): The University of Hong Kong

Cardiac rehabilitation is confined to those high-risk patients, such as those with acute myocardial infarction and heart failure. Most patients with coronary artery disease (CAD) are not eligible for this evidence-based therapy.

This study aimed to examine the feasibility and preliminary effects of a mobile intervention, titled "internet-based CArdiac Rehabilitation Enhancement (i-CARE)", on self-care behaviors, functional status, health-related quality of life (HRQoL), blood pressure, waist-to-height ratio and cholesterol level in patients with CAD.

This mixed-methods study comprised a pilot randomized controlled trial (RCT) and a qualitative phase. Patients in the intervention group received a 12-week i-CARE intervention, consisting of a single face-to-face orientation session and a mobile app consisting of three key user interfaces, including a self-monitoring dashboard with personalized interface according to their own risk profile, an interactive e-library covering various CAD-related self-care dimensions and a chat room for the nurse to provide continuous coaching and facilitate behavioral changes. The control group received standard care.

Fifty patients with CAD were randomly allocated to the intervention (n = 25) or control group (n = 25). The i-CARE intervention was feasible and acceptable to CAD patients. Participants gave excellent ratings in the satisfaction survey. The i-Care group showed greater improvements in self-care behaviors (β = 6.213, 95%CI: 1.924 – 12.236, p = 0.016), HRQoL (β = 6.132, 95%CI: 1.276 – 15.237, p = 0.032) and functional status (β = 2.584, 95%CI: 1.050 – 7.226, p = 0.039) than the standard care group at the immediate post-intervention. No significant between-group changes in blood pressure, cholesterol and waist-to-height ratio were detected. The average number of logins to the app by the intervention group was 92.84 (21.45) and 84% of them accessed all modules available in the app. A total of 4,987 hits to the exercise videos were recorded during the intervention period. Most of the participants (88%) actively initiated a discussion or responded in the chat room. The qualitative data converged with the quantitative data, indicating that the intervention was highly feasible and acceptable to CAD patients.

The i-Care intervention is feasible and acceptable to CAD patients. It improves patients’ self-care behaviors, HRQoL and functional status. A full-scale RCT is warranted to investigate the longer-term effects of this intervention.