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Effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the Smart HEART clinical trial

BACKGROUND: Cardiac rehabilitation (CR) improves outcomes in heart disease yet remains vastly underutilized. Remote CR enhanced with a digital health intervention (DHI) may offer higher access and improved patient-centered outcomes over non-technology approaches. We sought to pragmatically determine...

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Autores principales: Harzand, Arash, Alrohaibani, Alaaeddin, Idris, Muhammed Y., Spence, Hayden, Parrish, Cate G., Rout, Pratik K., Nazar, Rene, Davis-Watts, Michelle L., Wright, Phyllis P., Vakili, Alexander A., Abdelhamid, Smah, Vathsangam, Harshvardhan, Adesanya, Adelanwa, Park, Linda G., Whooley, Mary A., Wenger, Nanette K., Zafari, A. Maziar, Shah, Amit J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10496208/
https://www.ncbi.nlm.nih.gov/pubmed/37700245
http://dx.doi.org/10.1186/s12872-023-03471-w
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author Harzand, Arash
Alrohaibani, Alaaeddin
Idris, Muhammed Y.
Spence, Hayden
Parrish, Cate G.
Rout, Pratik K.
Nazar, Rene
Davis-Watts, Michelle L.
Wright, Phyllis P.
Vakili, Alexander A.
Abdelhamid, Smah
Vathsangam, Harshvardhan
Adesanya, Adelanwa
Park, Linda G.
Whooley, Mary A.
Wenger, Nanette K.
Zafari, A. Maziar
Shah, Amit J.
author_facet Harzand, Arash
Alrohaibani, Alaaeddin
Idris, Muhammed Y.
Spence, Hayden
Parrish, Cate G.
Rout, Pratik K.
Nazar, Rene
Davis-Watts, Michelle L.
Wright, Phyllis P.
Vakili, Alexander A.
Abdelhamid, Smah
Vathsangam, Harshvardhan
Adesanya, Adelanwa
Park, Linda G.
Whooley, Mary A.
Wenger, Nanette K.
Zafari, A. Maziar
Shah, Amit J.
author_sort Harzand, Arash
collection PubMed
description BACKGROUND: Cardiac rehabilitation (CR) improves outcomes in heart disease yet remains vastly underutilized. Remote CR enhanced with a digital health intervention (DHI) may offer higher access and improved patient-centered outcomes over non-technology approaches. We sought to pragmatically determine whether offering a DHI improves CR access, cardiac risk profile, and patient-reported outcome measures. METHODS: Adults referred to CR at a tertiary VA medical center between October 2017 and December 2021 were offered enrollment into a DHI alongside other CR modalities using shared decision-making. The DHI consisted of remote CR with a structured, 3-month home exercise program enhanced with multi-component coaching, a commercial smartphone app, and wearable activity tracker. We measured completion rates among DHI participants and evaluated changes in 6-min walk distance, cardiovascular risk factors, and patient-reported outcomes from pre- to post-intervention. RESULTS: Among 1,643 patients referred to CR, 258 (16%) consented to the DHI where the mean age was 60 ± 9 years, 93% were male, and 48% were black. A majority (90%) of the DHI group completed the program. Over 3-months, significant improvements were seen in 6MWT (mean difference [MD] -29 m; 95% CI, 10 to 49; P < 0.01) and low-density lipoprotein cholesterol (MD -11 mg/dL; 95% CI, -17 to -5; P < 0.01), and the absolute proportion of patients who reported smoking decreased (10% vs 15%; MD, -5%; 95% CI, -8% to -2%; P < 0.01) among DHI participants with available data. No adverse events were reported. CONCLUSIONS: The addition of a DHI-enhanced remote CR program was delivered in 16% of referred veterans and associated with improved CR access, markers of cardiovascular risk, and healthy behaviors in this real-world study. These findings support the continued implementation of DHIs for remote CR in real-world clinical settings. TRIAL REGISTRATION: This trial was registered on ClinicalTrials.gov: NCT02791685 (07/06/2016).
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spelling pubmed-104962082023-09-13 Effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the Smart HEART clinical trial Harzand, Arash Alrohaibani, Alaaeddin Idris, Muhammed Y. Spence, Hayden Parrish, Cate G. Rout, Pratik K. Nazar, Rene Davis-Watts, Michelle L. Wright, Phyllis P. Vakili, Alexander A. Abdelhamid, Smah Vathsangam, Harshvardhan Adesanya, Adelanwa Park, Linda G. Whooley, Mary A. Wenger, Nanette K. Zafari, A. Maziar Shah, Amit J. BMC Cardiovasc Disord Research BACKGROUND: Cardiac rehabilitation (CR) improves outcomes in heart disease yet remains vastly underutilized. Remote CR enhanced with a digital health intervention (DHI) may offer higher access and improved patient-centered outcomes over non-technology approaches. We sought to pragmatically determine whether offering a DHI improves CR access, cardiac risk profile, and patient-reported outcome measures. METHODS: Adults referred to CR at a tertiary VA medical center between October 2017 and December 2021 were offered enrollment into a DHI alongside other CR modalities using shared decision-making. The DHI consisted of remote CR with a structured, 3-month home exercise program enhanced with multi-component coaching, a commercial smartphone app, and wearable activity tracker. We measured completion rates among DHI participants and evaluated changes in 6-min walk distance, cardiovascular risk factors, and patient-reported outcomes from pre- to post-intervention. RESULTS: Among 1,643 patients referred to CR, 258 (16%) consented to the DHI where the mean age was 60 ± 9 years, 93% were male, and 48% were black. A majority (90%) of the DHI group completed the program. Over 3-months, significant improvements were seen in 6MWT (mean difference [MD] -29 m; 95% CI, 10 to 49; P < 0.01) and low-density lipoprotein cholesterol (MD -11 mg/dL; 95% CI, -17 to -5; P < 0.01), and the absolute proportion of patients who reported smoking decreased (10% vs 15%; MD, -5%; 95% CI, -8% to -2%; P < 0.01) among DHI participants with available data. No adverse events were reported. CONCLUSIONS: The addition of a DHI-enhanced remote CR program was delivered in 16% of referred veterans and associated with improved CR access, markers of cardiovascular risk, and healthy behaviors in this real-world study. These findings support the continued implementation of DHIs for remote CR in real-world clinical settings. TRIAL REGISTRATION: This trial was registered on ClinicalTrials.gov: NCT02791685 (07/06/2016). BioMed Central 2023-09-12 /pmc/articles/PMC10496208/ /pubmed/37700245 http://dx.doi.org/10.1186/s12872-023-03471-w Text en © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Harzand, Arash
Alrohaibani, Alaaeddin
Idris, Muhammed Y.
Spence, Hayden
Parrish, Cate G.
Rout, Pratik K.
Nazar, Rene
Davis-Watts, Michelle L.
Wright, Phyllis P.
Vakili, Alexander A.
Abdelhamid, Smah
Vathsangam, Harshvardhan
Adesanya, Adelanwa
Park, Linda G.
Whooley, Mary A.
Wenger, Nanette K.
Zafari, A. Maziar
Shah, Amit J.
Effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the Smart HEART clinical trial
title Effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the Smart HEART clinical trial
title_full Effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the Smart HEART clinical trial
title_fullStr Effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the Smart HEART clinical trial
title_full_unstemmed Effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the Smart HEART clinical trial
title_short Effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the Smart HEART clinical trial
title_sort effects of a patient-centered digital health intervention in patients referred to cardiac rehabilitation: the smart heart clinical trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10496208/
https://www.ncbi.nlm.nih.gov/pubmed/37700245
http://dx.doi.org/10.1186/s12872-023-03471-w
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