The Care Assessment Platform (CAP) is a mobile phone and internet technology based home-care cardiac rehabilitation (CR) service model developed to improve patient uptake and adherence compared to traditional CR programs. Methods: Post myocardial infarction patients (n = 120, age 56±10 yrs, 100 males)were randomised into hospitalbased (Control, n = 60) and CAP home-care (Intervention, n = 60) CR. The CAP was utilised for health and exercise monitoring, delivery of motivational and educational materials and messages to patients and sharing follow-up information with a case mentor over aninternet portal.The case mentor provided weekly consultations over the sixweek CR program. Uptake and adherencewere measured as well as health outcomes including functional capacity (6-minute walk test (6MWT), anthropometric and blood lipid profile, and emotional state (DASS21 Questionnaire). Results: Uptake in the Intervention group was significantly better than Controls (87% (n = 52) vs. 67% (n = 40) and the adherence rate was significantly higher in the Intervention (92%) than the Control (70%) group. There was significant improvement in the 6MWT walk distance from baseline to six weeks for both groups 543.8±80.3-594.2±74.3m and 509.9±76.9-569.6±80.5 m,respectively. Significant reductions in weight (88.9±20.4-87.9±20.7 kg) and triglyceride levels (1.26±0.75-1.11±0.68 mmol/L) were observed in the Intervention group. Emotional state also improved significantly in the Intervention group withDASS21 scores of median2, IQR6 to median0, IQR3 in both. Conclusion: The CAP service model demonstrated increased uptake and completion rate of CR programs compared to the traditional centre-based CR program, resulting in improvement in the over-all CR participation.
OBJECTIVE: Cardiac rehabilitation (CR) is pivotal in preventing recurring events of myocardial infarction (MI). This study aims to investigate the effect of a smartphone-based home service delivery (Care Assessment Platform) of CR (CAP-CR) on CR use and health outcomes compared with a traditional, centre-based programme (TCR) in post-MI patients.
METHODS: In this unblinded randomised controlled trial, post-MI patients were randomised to TCR (n=60; 55.7±10.4 years) and CAP-CR (n=60; 55.5±9.6 years) for a 6-week CR and 6-month self-maintenance period. CAP-CR, delivered in participants' homes, included health and exercise monitoring, motivational and educational material delivery, and weekly mentoring consultations. CAP-CR uptake, adherence and completion rates were compared with TCR using intention-to-treat analyses. Changes in clinical outcomes (modifiable lifestyle factors, biomedical risk factors and health-related quality of life) across baseline, 6 weeks and 6 months were compared within, and between, groups using linear mixed model regression.
RESULTS: CAP-CR had significantly higher uptake (80% vs 62%), adherence (94% vs 68%) and completion (80% vs 47%) rates than TCR (p<0.05). Both groups showed significant improvements in 6-minute walk test from baseline to 6 weeks (TCR: 537±86-584±99 m; CAP-CR: 510±77-570±80 m), which was maintained at 6 months. CAP-CR showed slight weight reduction (89±20-88±21 kg) and also demonstrated significant improvements in emotional state (K10: median (IQR) 14.6 (13.4-16.0) to 12.6 (11.5-13.8)), and quality of life (EQ5D-Index: median (IQR) 0.84 (0.8-0.9) to 0.92 (0.9-1.0)) at 6 weeks.
CONCLUSIONS: This smartphone-based home care CR programme improved post-MI CR uptake, adherence and completion. The home-based CR programme was as effective in improving physiological and psychological health outcomes as traditional CR. CAP-CR is a viable option towards optimising use of CR services.
TRIAL REGISTRATION NUMBER: ANZCTR12609000251224.
ABSTRACT: We conducted a cost benefit analysis of a home telehealth-based cardiac rehabilitation programme compared to the standard hospital-based programme. A total of 120 participants were enrolled in a trial, with 60 randomised to the telehealth group and 60 randomised to usual care. Participants in the telehealth group received a mobile phone, Wellness Diary and a Wellness web portal, with daily text messaging. Participants in the usual care group received the standard 6-week hospital-based outpatient cardiac rehabilitation programme, including gym sessions. The cost of delivery by telehealth was slightly lower than for patients attending a rehabilitation service in person. From the provider's perspective, the telehealth intervention could be delivered for $1633 per patient, compared to $1845 for the usual care group. From the participant's perspective, patient travel costs for home rehabilitation were substantially less than for hospital attendance ($80 vs $400). Cardiac rehabilitation by telehealth offers obvious advantages and the option should be available to all patients who are eligible for cardiac rehabilitation.
