Rationale and Design of the mTECH-Rehab Randomized Controlled Trial: Impact of a Mobile Technology Enabled Corrie Cardiac Rehabilitation Program on Functional Status and Cardiovascular Health

Abstract

Background: Cardiac rehabilitation (CR) is an evidence-based, guideline-recommended intervention for patients recovering from a cardiac event, surgery or procedure that improves morbidity, mortality, and functional status. CR is traditionally provided in-center, which limits access and engagement, most notably among underrepresented racial and ethnic groups due to barriers including cost, scheduling, and transportation access. This study is designed to evaluate the Corrie Hybrid CR, a technology-based, multicomponent health equity-focused intervention as an alternative to traditional in-center CR among patients recovering from a cardiac event, surgery, or procedure compared with usual care alone.

Methods: The mTECH-Rehab (Impact of a Mobile Technology Enabled Corrie CR Program) trial will randomize 200 patients who either have diagnosis of myocardial infarction or who undergo coronary artery bypass grafting surgery, percutaneous coronary intervention, heart valve repair, or replacement presenting to 4 hospitals in a large academic health system in Maryland, United States, to the Corrie Hybrid CR program combined with usual care CR (intervention group) or usual care CR alone (control group) in a parallel arm, randomized controlled trial. The Corrie Hybrid CR program leverages 5 components: (1) a patient-facing mobile application that encourages behavior change, patient empowerment, and engagement with guideline-directed therapy; (2) Food and Drug Administration-approved smart devices that collect health metrics; (3) 2 upfront in-center CR sessions to facilitate personalization, self-efficacy, and evaluation for the safety of home exercise, followed by a combination of in-center and home-based sessions per participant preference; (4) a clinician dashboard to track health data; and (5) weekly virtual coaching sessions delivered over 12 weeks for education, encouragement, and risk factor modification. The primary outcome is the mean difference between the intervention versus control groups in distance walked on the 6-minute walk test (ie, functional capacity) at 12 weeks post randomization. Key secondary and exploratory outcomes include improvement in a composite cardiovascular health metric, CR engagement, quality of life, health factors (including low-density lipoprotein-cholesterol, hemoglobin A1c, weight, diet, smoking cessation, blood pressure), and psychosocial factors. Approval for the study was granted by the local institutional review board. Results of the trial will be published once data collection and analysis have been completed.

Conclusions: The Corrie Hybrid CR program has the potential to improve functional status, cardiovascular health, and CR engagement and advance equity in access to cardiac rehabilitation.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05238103.

Keywords: cardiac rehabilitation; cardiovascular diseases; digital health; health behavior; health technology; mobile applications; secondary prevention.

Figure 1. mTECH‐Rehab study flow diagram.

ASCVD indicates atherosclerotic cardiovascular disease; BP, blood pressure; CABG, coronary artery bypass graft surgery; CR, cardiac rehabilitation; LDL‐C, low density lipoprotein cholesterol; NSTEMI, non–ST‐segment–elevation myocardial infarction; PCI, percutaneous coronary intervention; and STEMI, ST‐segment–elevation myocardial infarction

Figure 2. Components of the Corrie Hybrid Cardiac Rehabilitation Program.

Corrie Hybrid Cardiac Rehabilitation Program components include (1) a patient‐facing smartphone app, (2) Food and Drug Administration‐approved smart devices (blood pressure machine, smartwatch), (3) weekly coaching calls, (4) a clinician dashboard, and (5) at least 2 in‐person cardiac rehabilitation sessions (not pictured). UX indicates user experience.

Figure 3. Corrie Hybrid Cardiac Rehabilitation smartphone application.

Shown here are various features and tabs within the Corrie smartphone application, including vitals, physical activity, medication tracking, educational materials, and clinical team contacts.