Smartphones in the secondary prevention of cardiovascular disease: a systematic review

Sandra J Hamilton,Eleanor M Birch,Belynda Mills,Sandra C Thompson

doi:10.1186/s12872-018-0764-x

Abstract

BackgroundCardiac Rehabilitation (CR) and secondary prevention are effective components of evidence-based management for cardiac patients, resulting in improved clinical and behavioural outcomes. Mobile health (mHealth) is a rapidly growing health delivery method that has the potential to enhance CR and heart failure management. We undertook a systematic review to assess the evidence around mHealth interventions for CR and heart failure management for service and patient outcomes, cost effectiveness with a view to how mHealth could be utilized for rural, remote and Indigenous cardiac patients.MethodsA comprehensive search of databases using key terms was conducted for the years 2000 to August 2016 to identify randomised and non-randomised trials utilizing smartphone functionality and a model of care that included CR and heart failure management. Included studies were assessed for quality and risk of bias and data extraction was undertaken by two independent reviewers.ResultsNine studies described a mix of mHealth interventions for CR (5 studies) and heart failure (4 studies) in the following categories: feasibility, utility and uptake studies; and randomised controlled trials. Studies showed that mHealth delivery for CR and heart failure management is feasible with high rates of participant engagement, acceptance, usage, and adherence. Moreover, mHealth delivery of CR was as effective as traditional centre-based CR (TCR) with significant improvement in quality of life. Hospital utilization for heart failure patients showed inconsistent reductions. There was limited inclusion of rural participants.ConclusionMobile health delivery has the potential to improve access to CR and heart failure management for patients unable to attend TCR programs. Feasibility testing of culturally appropriate mHealth delivery for CR and heart failure management is required in rural and remote settings with subsequent implementation and evaluation into local health care services.

Highlights

Cardiac Rehabilitation (CR) and secondary prevention are effective components of evidence-based management for cardiac patients, resulting in improved clinical and behavioural outcomes
The included articles described a mix of Mobile health (mHealth) interventions for CR (Tables 3, 4 and 5) and heart failure (Tables 6, 7 and 8) of two key types: (1) Feasibility, utility and uptake (FUU) studies: observational studies focussing on the feasibility and/or utility of
The efficacy of mHealth was comparable to traditional centre-based CR, reductions in hospital service utilization for heart failure patients was inconsistent. mHealth has the potential to be an effective method of delivering CR and heart failure management and improving access for patients unable to attend traditional centre-based rehabilitation programs, larger high quality studies are required for more definitive conclusions to be drawn

Summary

Introduction

Cardiac Rehabilitation (CR) and secondary prevention are effective components of evidence-based management for cardiac patients, resulting in improved clinical and behavioural outcomes. Cardiac Rehabilitation (CR) and secondary prevention are components of evidence-based management assisting patients with CVD (coronary artery disease, heart failure, atrial fibrillation and peripheral artery disease) return to an active and satisfying life through. Secondary prevention, is defined as “healthcare designed to prevent recurrence of cardiovascular events or complications of CVD in patients diagnosed with CVD” [7] These definitions are similar, CR may be time limited, whereas secondary prevention proposes a cardiac rehabilitation continuum where care is provided for the rest of a person’s life according to need [7]. Low CR attendance rates can reflect factors at the health service and broader system level, and well as health professional and patient related factors These are significantly greater for people who live in rural and remote settings [8,9,10,11]. Systems and health professional related barriers limit accessibility through referral failure [8], absence of local CR programs and limited program places [8], program inflexibility [8, 10, 11], and failure to meet the needs of individual patients [10]

Methods

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Discussion

Conclusion