Effect of a lifestyle-focused web-based application on risk factor management in post-myocardial infarction patients: a randomized controlled trial (Preprint)

Abstract

Cardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction (MI). However, fulfilment of guideline recommended cardiac rehabilitation targets is currently unsatisfactory. eHealth offers new possibilities to improve clinical care.

The aim of this randomized controlled trial was to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to centre-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care).

All patients participated in cardiac rehabilitation and patients randomized to the intervention group received access to a web-based application for 25 weeks where information about lifestyle (i.e., diet, physical activity, smoking), risk factors (i.e., weight, blood pressure), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was change in submaximal exercise capacity (Watts (W)) between follow-up visits at 2-weeks and 4-months post-MI. Secondary outcomes included changes in lifestyle and modifiable risk factors between baseline and 2-weeks, 6-10-weeks and 12–14-month follow-up visits, and uptake and adherence to the web-based application. Regression analysis was used, adjusting for relevant baseline variables.

We recruited 150 patients (81% men, 60.4±8.8 years). There was a non-significant trend towards a larger change in exercise capacity in the intervention group (n=66) compared to the usual care group (n=40) (+14.4±19.0 vs. +10.3±16.1 W, P=.22). Patients in the intervention group achieved significantly larger blood pressure reduction compared to usual care patients at 2-weeks (systolic -27.7 vs. -16.4 mmHg, P=.006) and at 6-10- weeks (systolic -25.3 vs. -16.4 mmHg, P=.02, and diastolic -13.4 vs -9.1, P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs. +1.4 points, P =.05), mostly due to an increase in the consumption of fish and fruit. At 6-10-weeks, 73% vs. 46% of smokers in the intervention vs. usual care groups had quit smoking, and at 12-14-months the respective percentages were 58% vs. 36%. The number of smokers in the study was however low (n=33) and the differences non-significant. No differences were observed in other secondary endpoints. Attendance in cardiac rehabilitation was high, with 97% of patients in the intervention group and 100% of patients receiving usual care only attending 12-14-month follow-up. Uptake (logging data in the application at least once) was 86%. Adherence (logging data at least twice per week) was 91% in week 1 and 56% in week 25.

Complementing cardiac rehabilitation with a web-based application improved blood pressure and healthy food habits during the first months after MI. Also, a non-significant tendency towards better exercise capacity and higher smoking cessation rates were observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation.

ClinicalTrials.gov, NCT03260582. Retrospectively registered on 24 August 2017.

RR2-10.1186/s13063-018-3118-1