A smartphone-based home service improved uptake, compliance and completion of cardiac rehabilitation compared with a traditional centre-based programme, a study from Australia has shown. Health outcomes were similar with both approaches.

A total of 120 patients who had had a myocardial infarction (MI) took part in the unblinded, randomised controlled trial. Half the patients, mean age 55.7 ± 10.4 years, were randomised to a centre-based programme and the other half, mean age 55.5 ± 9.6 years, to a smartphone-based programme. The vast majority of patients, 82% and 85% respectively, were male.

The initial programme was for six weeks with a six-month self-maintenance period. The smartphone programme (Care Assessment Platform) was delivered in patients’ homes and included health and exercise monitoring, motivational and educational material, and weekly mentoring consultations.

Uptake, adherence and completion rates were compared with the traditional centre-based programme using intention-to-treat analyses. Changes in clinical outcomes such as modifiable lifestyle factors, biomedical risk factors and health-related quality of life were assessed at baseline, six weeks and six months and compared within and between groups.

The smartphone-based programme had significantly higher uptake (80%) than the traditional centre-based programme (62%). Adherence rates (94% vs 68%) and completion rates (80% vs 47%) were also significantly better (P < 0.05).

There were significant improvements in the six-minute walk test from 510 ± 77 metres at baseline to 570 ± 80 metres in the smartphone group and from 537 ± 86 metres to 584 ± 99 metres in the group on the traditional programme. These improvements were maintained at six months.

Patients on the smartphone programme showed a small reduction in weight and also demonstrated significant improvements in emotional state and quality of life assessments at six weeks.

Cardiac rehabilitation is an essential component in the contemporary management of coronary heart disease. Enrolment in, and completion of, a well organised cardiac rehabilitation programme is effective in the prevention of recurrent events following MI.

However, more often than not the challenge lies in effective patient engagement. Programmes that use novel approaches are welcome if they can increase the delivery of this key, and often overlooked, intervention.

The authors conclude that a smartphone-based home care cardiac rehabilitation programme improved post-MI rehabilitation uptake, adherence and completion. Importantly, not only were patients more effectively engaged with the home-based programme but this method was also as effective in improving physiological and psychological health outcomes as a traditional programme.

Studies such as this, albeit small, are important in providing cardiac rehabilitation programmes with the evidence they require to innovate and improve the uptake of this important intervention.

Dr Peter Savill