An internet-based cardiac rehabilitation intervention for patients with coronary artery disease: a pilot feasibility analysis

Abstract

Background: Cardiac rehabilitation is confined to those high‐risk patients, such as those with acute myocardial infarction and heart failure. Most patients with coronary artery disease (CAD) are not eligible for this evidence‐based therapy. Purpose: This study aimed to examine the feasibility and preliminary effects of a mobile intervention, titled 'internet‐based CArdiac Rehabilitation Enhancement (i‐CARE)', on self‐care behaviors, functional status, health‐related quality of life (HRQoL), blood pressure, waist‐to‐height ratio and cholesterol level in patients with CAD. Methods: This mixed‐methods study comprised a pilot randomized controlled trial (RCT) and a qualitative phase. Patients in the intervention group received a 12‐week i‐CARE intervention, consisting of a single face‐to‐face orientation session and a mobile app consisting of three key user interfaces, including a self‐monitoring dashboard with personalized interface according to their own risk profile, an interactive e‐library covering various CAD‐related self‐care dimensions and a chat room for the nurse to provide continuous coaching and facilitate behavioral changes. The control group received standard care. Results: Fifty patients with CAD were randomly allocated to the intervention (n = 25) or control group (n = 25). The i‐CARE intervention was feasible and acceptable to CAD patients. Participants gave excellent ratings in the satisfaction survey. The i‐Care group showed greater improvements in self‐care behaviors ( = 6.213, 95%CI: 1.924 ‐ 12.236, p = 0.016), HRQoL ( = 6.132, 95%CI: 1.276 ‐ 15.237, p = 0.032) and functional status ( = 2.584, 95%CI: 1.050 ‐ 7.226, p = 0.039) than the standard care group at the immediate post‐intervention. No significant between‐group changes in blood pressure, cholesterol and waist‐to‐height ratio were detected. The average number of logins to the app by the intervention group was 92.84 (21.45) and 84% of them accessed all modules available in the app. A total of 4,987 hits to the exercise videos were recorded during the intervention period. Most of the participants (88%) actively initiated a discussion or responded in the chat room. The qualitative data converged with the quantitative data, indicating that the intervention was highly feasible and acceptable to CAD patients. Conclusion: The i‐Care intervention is feasible and acceptable to CAD patients. It improves patients' self‐care behaviors, HRQoL and functional status. A full‐scale RCT is warranted to investigate the longer‐term effects of this intervention.