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. 2021 Feb 8;23(2):e18773.
doi: 10.2196/18773.

Digital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review

Shannon Wongvibulsin  1 , Evagelia E Habeos  2 , Pauline P Huynh  1 , Helen Xun  1 , Rongzi Shan  3   4 , Kori A Porosnicu Rodriguez  1 , Jane Wang  1   4 , Yousuf K Gandapur  5 , Ngozi Osuji  3 , Lochan M Shah  1 , Erin M Spaulding  6 , George Hung  1 , Kellen Knowles  7 , William E Yang  1 , Francoise A Marvel  3 , Eleanor Levin  8 , David J Maron  9 , Neil F Gordon  10   11 , Seth S Martin  3
Affiliations

Digital Health Interventions for Cardiac Rehabilitation: Systematic Literature Review

Shannon Wongvibulsin et al. J Med Internet Res. .

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR.

Objective: The objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions.

Methods: Our strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018.

Results: Our search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure.

Conclusions: Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions.

Keywords: cardiac rehabilitation; digital technologies; mHealth; mobile phone; telemedicine.

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Conflict of interest statement

Conflicts of Interest: FM and SM are founders of and hold equity in Corrie Health, which intends to further develop the digital platform. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflicts of interest policies. Outside of the present work, they have received material support from Apple and iHealth and funding from the Maryland Innovation Initiative, Wallace H. Coulter Translational Research Partnership, Louis B. Thalheimer Fund, the Johns Hopkins Individualized Health Initiative, and the American Heart Association. SM reports personal fees for serving on scientific advisory boards for Akcea Therapeutics, Amgen, AstraZeneca, DalCor Pharmaceuticals, Esperion, Novo Nordisk, Quest Diagnostics, Regeneron, Sanofi, and 89bio. SM is a coinventor with a pending patent filed by the Johns Hopkins University for a system of low-density lipoprotein cholesterol estimation. EL is a scientific advisor for Moving Analytics. NG is the managing member of a population health management company, INTERVENT International, LLC.

Figures

Figure 1
Figure 1
Flowchart for study identification, screening, eligibility, and inclusion. CR: cardiac rehabilitation.
Figure 2
Figure 2
Percentage of studies with (1) the cardiac rehabilitation (CR) core components being addressed through digital interventions (apart from baseline assessment, which was conducted in person), (2) the technology modalities used in digital CR interventions, (3) the types of personnel employed in each CR program, and (4) the key outcomes evaluated. Cumulative percentages in some instances exceed 100% because some studies looked at multiple traits (n=31). BP: blood pressure; CR: cardiac rehabilitation; ECG: electrocardiogram; HR: heart rate; PT: physical therapist.
See this image and copyright information in PMC

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