A clinical study of patients with cardiovascular disease by Queensland Cardiovascular Group has found that offering a digital health platform, Cardihab, substantially improved participation rates in cardiac rehabilitation.
The findings were published in cardiovascular medicine journal JMIR Cardio and revealed that participation in cardiac rehabilitation improved from 21% to 63% when app-based cardiac rehabilitation (SmartCR) was offered as an alternative in addition to a conventional in-person program.
Cardihab provides a digital platform and patient apps (SmartCR) that facilitate the virtual delivery of cardiac rehabilitation and chronic disease management programs for patients recovering from cardiac events and living with heart disease.
The study involved 204 patients who were offered cardiac rehabilitation post angioplasty.
Cohort 1 comprised 99 patients who were offered conventional cardiac rehabilitation only. Cohort 2 comprised 105 patients who were offered Cardihab as an alternative if they declined conventional cardiac rehabilitation.
Patients in each cohort were monitored throughout a 6-week cardiac rehabilitation program, and participation rates were compared for both groups.
Dr John T Rivers, director of the Queensland Cardiovascular Group and lead author, said that cardiac rehabilitation was recommended and improved outcomes for patients, but poor patient uptake remained a challenge.
“The emphasis on continued close involvement by the clinical team was a key success factor. The inclusion of digital health should be considered as another tool in program delivery. Cardiac rehabilitation reduces cardiovascular mortality and increase quality of life, but many people don’t participate because of geographic distance or lack of transport, time constraints as well as cultural, cost and psychological barriers. The improved uptake of cardiac rehabilitation following the addition of SmartCR suggests that a significant number of patients will benefit from the convenience and flexibility of a remotely delivered virtual program. The low readmission rates were also an encouraging outcome that warrants further exploration.” [Dr Rivers]
Helen Souris, Cardihab’s chief executive officer, said that Cardihab enables patients to participate in a care plan that fits within their life.
The structured yet personalized program means that patients are getting high-quality care, while completing a specific program tailored to their individual needs.
“Cardihab provides an important option to help overcome barriers to participation in conventional in-person cardiac rehabilitation programs. Patients do not have to travel long distances to attend a program – they complete it from home while under clinical supervision. Cardihab also helps fit in with peoples’ busy work schedules and family commitments, and alleviates cost and time constraints associated with traditional programs. It has been a critical alternative particularly during COVID-19 whereby significant disruptions to traditional programs have been experienced Australia wide, and social distancing requirements presented further barriers to participation.”[Ms Souris]
Other key insights
- App-based cardiac rehabilitation offered to those declining conventional cardiac rehabilitation can improve participation rates;
- The study found that providing the additional option of Cardihab was associated with an increase of 42% in overall cardiac rehabilitation participation;
- Participation in conventional in-person cardiac rehabilitation in Cohort 1 was 21% while that with the added option of Cardihab in Cohort 2 was 63%;
- Approximately 23% of patients in Cohort 2 who declined any cardiac rehabilitation program identified technology issues as the reason why they declined use of the digital platform. Approximately 26% did not participate in either conventional or digital cardiac rehabilitation because they were scheduled for further cardiac procedures. Others declined because of psychosocial issues, frailty or comorbidities, and other reasons;
- This study was not powered to address differences in readmission rates, but the very low rate of 4% observed for app-based cardiac rehabilitation compared to that in other groups is hypothesis-generating.
- Readmission after major cardiac events is a significant and costly problem , with 30-day rates estimated between 6%-27% and 12-month rates estimated at 20%-30%.