The effect of mobile applications for improving adherence in cardiac rehabilitation: a systematic review and meta-analysis

Linqi Xu,Chengcheng Hong,Jinwei Li,Qian Tong,Feng Li,Changli Zhou

doi:10.1186/s12872-019-1149-5

Abstract

BackgroundDespite of the established effectiveness, the acceptance and adherence of cardiac rehabilitation (CR) remains sub-optimal. Mobile technologies are increasingly used in promoting CR without any firm evidence of their safety and efficacy. This systematic review and meta-analysis were aimed to assess the effect of mobile applications as an intervention for improving adherence to CR.MethodsRelevant studies were searched in PubMed, the Cochrane Library, Embase and Web of Science from inception to 29th December 2018. Eligible studies were the ones which used mobile applications as a stand-alone intervention or as the primary component for the intervention directed at improving CR adherence, without any limitations on outpatient or home-based CR.ResultsEight studies were eligible for the systematic review including four randomized controlled trials (RCTs) as well as four before-after studies of which only one had control group. Four RCTs and 185 patients in experimental group were included in meta-analysis, which had evaluated the effect of mobile health applications on CR completion and had reported that the adherence of patients using mobile applications was 1.4 times higher than the control group (RR = 1.38; CI 1.16 to 1.65; P = 0.0003). Moreover, we also found mixed results in exercise capacity, mental health and quality of life.ConclusionThe use of mobile applications for improving the adherence of the CR might be effective. However, it appears to be in the initial stage of implementing mobile applications in CR and more research is essential to validate their effectiveness.

Highlights

Despite of the established effectiveness, the acceptance and adherence of cardiac rehabilitation (CR) remains sub-optimal
Despite of the proven benefits and guideline recommendations, the uptake and adherence remains sub-optimal in almost all countries wherever CR is available, with only 30% of eligible patients participating in the UK and the USA [10,11,12], approximately 30% of eligible patients in Canada, and a little higher at around 50% in the rest of European countries [13]
Our results have indicated that mobile applications in CR may improve the adherence of CR in current scenario

Summary

Introduction

Despite of the established effectiveness, the acceptance and adherence of cardiac rehabilitation (CR) remains sub-optimal. According to the American Heart Association (AHA)/ American College of Cardiology (ACC) [3, 4] and the European Society of Cardiology (ESC) [5], cardiac rehabilitation (CR) is a class IA recommendation for patients with CVD and has been demonstrated to reduce cardiac and all-cause mortality, fewer cardiac events and less re-hospitalization [6,7,8,9]. Despite of the proven benefits and guideline recommendations, the uptake and adherence remains sub-optimal in almost all countries wherever CR is available, with only 30% of eligible patients participating in the UK and the USA [10,11,12], approximately 30% of eligible patients in Canada, and a little higher at around 50% in the rest of European countries [13]. It is clear that the traditional CR does not meet the needs of many eligible patients, and improvement in CR program is required to enhance its utilization

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