SMARTphone and Social Media-Based Cardiac Rehabilitation and Secondary Prevention in China (SMART-CR/SP): A Randomised Controlled Trial

Abstract

Background: Coronary heart disease (CHD) is rapidly increasing in developing countries, but access to cardiac rehabilitation and secondary prevention (CR/SP) remains low. We assessed the effectiveness of SMARTphone and WeChat-based CR/SP (SMART-CR/SP) in the first randomised controlled trial (RCT) of a dedicated social media-based CR/SP program for patients with CHD. Methods: In this parallel-group, single-blind, RCT, CHD patients from a large tertiary hospital in Shanghai, China were randomised (1:1) to an eight-week 'intensive', followed by a 16-week 'step down' program of SMART-CR/SP, or usual care. Assessments were conducted at baseline, eight and 24 weeks. The primary outcome was functional capacity measured by six-minute walk test distance (6MWTD). Secondary outcomes included CHD knowledge, and risk factor control. Analysis was by intention-to-treat. Findings: Between November 17, 2016 and March 18, 2017, 312 patients (mean age, 60.5 [SD 9.2] years, 81.4% male) were randomised to SMART-CR/SP (n=156) or usual care (n=156). The mean increase in 6MWTD was greater at both eight (46.5 vs. 20.9 m; 95% CI 9.6 to 41.5; p=0.002) and 24 weeks (54.2 vs. 26.2 m; 95% CI 10.9 to 44.9; p=0.001) in the SMART-CR/SP group versus controls. The SMART-CR/SP group had a better knowledge of CHD score at eight (17.9 vs. 13.8; 95% CI 2.84 to 5.44; p<0.001) and 24 weeks (17.9 vs. 13.7; 95% CI 2.91 to 5.51; p<0.001), and adherence to core cardioprotective medications at eight (OR 1.95, 95% CI 1.23 to 3.07; p=0.004) and 24 weeks (OR 1.82, 95% CI 1.11 to 2.97; p=0.017). Systolic blood pressure (123.2 vs. 131.8 mm Hg; 95% CI -16.4 to -0.9; p=0.029) and resting heart rate (69.3 vs. 75.4 bpm; 95% CI -11.9 to 0.3; p=0.039) were improved following 24 weeks of SMART-CR/SP, but not control. Interpretation: SMART-CR/SP provided an effective CR/SP service model that was low cost and easy to access. These results justify implementation of similar models of care on a broader scale. Trial Registration: Trial registration was with http://www.chictr.org.cn (ChiCTR-INR-16009598). Funding Statement: PhD scholarship from Curtin University (TD). Other expenses were met by research funds held by AM/BKT at Curtin University. Blood pressure monitors were donated by Sky Innovation Technology Ltd. Declaration of Interests: The blood pressure monitors used in the study were donated by Sky Innovation Technology Ltd. TD received a PhD research scholarship from Curtin University. All other authors declare no competing interests. Ethics Approval Statement: The Human Research Ethics Committee of Fudan University Zhongshan Hospital granted the primary ethics approval for the trial (B2016-058) with reciprocal approval provided by the Curtin University Human Research Ethics Office (HRE2016-0120).