Sio Wa Lao
The Chinese University of Hong Kong, Hong Kong
Title: The effects of electronic application on cardiac Rehabilitation for coronary heart disease patients Undergone percutaneous coronary intervention: A literature review
Biography
Biography: Sio Wa Lao
Abstract
INTRODUCTION
Literatures indicate an underutilized level of cardiac rehabilitation (CR) referral and participation worldwide. Only one-third of eligible coronary heart disease (CHD) patients after coronary revascularization would attend CR. In western countries, CR referral rate of CHD patient was around 40% and the 36% -80% of MI patients would attend CR. The data in Asian countries was much more unsatisfied, compared with that in western. By 2014, the CR participation rate of CHD patient in China was only 14.3%. In Hong Kong, 21% of post-MI patients participated in phase II CR in 2005. Factors associated with conventional CR non-participation include female, elderly, low education, lack of transport, busy working schedule, low financial support or lack of insurance, and preference of self exercise in the literature. To improve the adherence and effects of CR, eHealth and mHealth are adopted to enhance healthy lifestyle modification and medical therapy; to improve self-care management and quality of life; and potentially to decrease the risk of recurrent events.
AIM
To identify the program care characteristics and to evaluate the effectiveness of eHealth or mHealth application in CR for post PCI patients.
METHODS
Keywords of “coronary heart disease (CHD), myocardial infarction (MI) or ischeamic heart disease (IHD)” and “percutaneous coronary intervention (PCI) or coronary intervention” and “eHealth”, “mHealth”, “mobile”, “Smartphone” or “technology” and “telerehab*”, “cardiac rehab*” or “secondary prevention” were used. Databases of CINAHL, Medline, EMBASE, Cochrane Library, Joanna Bridge Institute, PsychINFO, and Social Work Abstracts were searched. Studies published in English between 2006 and 2016 were included.
Eligible studies were assessed according to the following PICOS.
1). Population/ participants (P): adult patients with the diagnosis of CHD and underwent PCI or other coronary intervention;
2). Intervention (I): CR or any component of CR delivered through eHealth/ mHealth;
3). Comparison (C): comparisons with usual care or conventional CR;
4). Outcomes (O): Patient’s clinical outcomes, such as physical, psychological and social indicators, mortality and adverse events, and economical outcomes, e.g. health care utility;
5). Study (S): experimental studies.
RESULTS
Sixty-four studies were found following the searching strategy and nine studies were identified according to the PICOS. Overall, 69% (n=9) of the studies were published between 2010 to 2015.
Two fifths of them (n=5, 40%) were conducted in Europe and nearly one thirds of them (n=4, 30%) were in North America. Study sample size varied from 39 to 11,862, with the study duration ranging from 4-week to 6-month. To appraise the quality of the nine reviewed studies, “Quality Assessment Tool for Quantitative Studies” was used. For the global rating quality, 44% (n=4) of the studies were rated as strong and 56% (n=5) were moderate.
Internet-based, mobile-based and smartphone-based CR had been tested against conventional CR. In general, the alternative CR programs covered comprehensive components on exercise, medication, diet, CHD risk factor control, and healthy behavior change.
Commonly, the stydies lacked a theory to underpinned their study design. All the reviewed studies assessed the outcomes of exercise capacity/ frequency of physical activity and majority of them (88%, n=8) achieved significant improvements in the alternative CR group. Six studies (66%) improved the anxiety/ depression level and QoL/ health-related quality of life. Five studies (55%) reported physiological outcomes improvements, including blood pressure, heart rate, body mass index, lipid profile, fasting blood glucose and some studies achieved significant improvements. However, limited studies (n=2) measured medication adherence.
Among those electronic CR programs achieving significant effects in promoting physical exercise, QoL, medication and diet adherence, and cardiovascular risk factors control, they commonly applied interaction with patients via text message and self-monitor in personal health outcomes. Four studies (45%) applied smart-phone based interventions and 80% of the outcomes achieved significant improvements while 5 studies (55%) were internet plus mobile-phone based but reported improvements in 57% of the outcomes. The literatures also indicated better assessability and convenience in mobile or smartphone-based CR programs, compared with internet-based design. Limited studies applied any health behaviour change theory to guide the development of the alternative CR.
CONCLUSION
A theoretical framework underpinned, smartphone-based intervention is indicated to support post PCI patients engaging in CR, particularly for Chinese population. To maximize the effects of CR on patient outcomes and reducing unnecessary health care utility, mCR program is recommended to motivate and help the post PCI patients adhere to their medical therapy, physical and diet recommendation. Also, patients’ self-care skills and self-efficacy on managing their life-long illness could also be measured in future studies.