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Meta-Analysis
. 2022 Dec 2;10(12):e39593.
doi: 10.2196/39593.

Effectiveness of mHealth Interventions in the Control of Lifestyle and Cardiovascular Risk Factors in Patients After a Coronary Event: Systematic Review and Meta-analysis

Celia Cruz-Cobo  1   2   3 , María Ángeles Bernal-Jiménez  1   2   3 , Rafael Vázquez-García  2   4 , María José Santi-Cano  1   2   3
Affiliations
Meta-Analysis

Effectiveness of mHealth Interventions in the Control of Lifestyle and Cardiovascular Risk Factors in Patients After a Coronary Event: Systematic Review and Meta-analysis

Celia Cruz-Cobo et al. JMIR Mhealth Uhealth. .

Abstract

Background: Coronary artery disease is the main cause of death and loss of disability-adjusted life years worldwide. Information and communication technology has become an important part of health care systems, including the innovative cardiac rehabilitation services through mobile phone and mobile health (mHealth) interventions.

Objective: In this study, we aimed to determine the effectiveness of different kinds of mHealth programs in changing lifestyle behavior, promoting adherence to treatment, and controlling modifiable cardiovascular risk factors and psychosocial outcomes in patients who have experienced a coronary event.

Methods: A systematic review of the literature was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A thorough search of the following biomedical databases was conducted: PubMed, Embase, Web of Science, SciELO, CINAHL, Scopus, The Clinical Trial, and Cochrane. Articles that were randomized clinical trials that involved an intervention consisting of an mHealth program using a mobile app in patients after a coronary event were included. The articles analyzed some of the following variables as outcome variables: changes in lifestyle behavior, cardiovascular risk factors, and anthropometric and psychosocial variables. A meta-analysis of the variables studied was performed with the Cochrane tool. The risk of bias was assessed using the Cochrane Collaboration tool; the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation tool; and heterogeneity was measured using the I2 test.

Results: A total of 23 articles were included in the review, and 20 (87%) were included in the meta-analysis, with a total sample size of 4535 patients. Exercise capacity measured using the 6-minute walk test (mean difference=21.64, 95% CI 12.72-30.55; P<.001), physical activity (standardized mean difference [SMD]=0.42, 95% CI 0.04-0.81; P=.03), and adherence to treatment (risk difference=0.19, 95% CI 0.11-0.28; P<.001) were significantly superior in the mHealth group. Furthermore, both the physical and mental dimensions of quality of life were better in the mHealth group (SMD=0.26, 95% CI 0.09-0.44; P=.004 and SMD=0.27, 95% CI 0.06-0.47; P=.01, respectively). In addition, hospital readmissions for all causes and cardiovascular causes were statistically higher in the control group than in the mHealth group (SMD=-0.03, 95% CI -0.05 to -0.00; P=.04 vs SMD=-0.04, 95% CI -0.07 to -0.00; P=.05).

Conclusions: mHealth technology has a positive effect on patients who have experienced a coronary event in terms of their exercise capacity, physical activity, adherence to medication, and physical and mental quality of life, as well as readmissions for all causes and cardiovascular causes.

Trial registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42022299931; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299931.

Keywords: acute coronary syndrome; coronary disease; mobile apps; mobile health; mobile phone; smartphone.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of the study selection process. CVD: cardiovascular disease.
Figure 2
Figure 2
Risk of bias summary: authors’ judgments about each risk of bias item for each included trial.
Figure 3
Figure 3
Risk of bias graph: authors’ judgments about each risk of bias item presented as percentages across all included trials.
Figure 4
Figure 4
Forest plots for changes in the 6-minute walk test. IV: instrumental variable; mHealth: mobile health.
Figure 5
Figure 5
Forest plots for changes in physical exercise. IV: instrumental variable; mHealth: mobile health.
Figure 6
Figure 6
Forest plots for changes in quality of life (physical dimension or physical health). IV: instrumental variable; mHealth: mobile health.
Figure 7
Figure 7
Forest plots for changes in quality of life (mental dimension or mental health). IV: instrumental variable; mHealth: mobile health.
Figure 8
Figure 8
Forest plots for changes in adherence to medication. IV: instrumental variable; mHealth: mobile health.
Figure 9
Figure 9
Forest plots for changes in rehospitalizations for all causes. IV: instrumental variable; mHealth: mobile health.
Figure 10
Figure 10
Forest plots for changes in rehospitalizations for cardiovascular causes. IV: instrumental variable; mHealth: mobile health.
See this image and copyright information in PMC

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