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Hou QL, Liu LY, Wu Y. The Effects of mHealth Interventions on Quality of Life, Anxiety, and Depression in Patients With Coronary Heart Disease: Meta-Analysis of Randomized Controlled Trials. J Med Internet Res 2024; 26:e52341. [PMID: 38861710 DOI: 10.2196/52341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/05/2024] [Accepted: 03/22/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is the leading cause of death globally. In addition, 20% to 40% of the patients with CHD have comorbid mental health issues such as anxiety or depression, affecting the prognosis and quality of life (QoL). Mobile health (mHealth) interventions have been developed and are widely used; however, the evidence for the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD is currently ambiguous. OBJECTIVE In this study, we aimed to assess the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD. METHODS We searched the Cochrane Library, PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure, and Wanfang databases from inception to August 12, 2023. Eligible studies were randomized controlled trials that involved patients with CHD who received mHealth interventions and that reported on QoL, anxiety, or depression outcomes. We used the Cochrane risk-of-bias tool for randomized trials to evaluate the risk of bias in the studies, ensuring a rigorous and methodologically sound analysis. Review Manager (desktop version 5.4; The Cochrane Collaboration) and Stata MP (version 17.0; StataCorp LLC) were used to conduct the meta-analysis. The effect size was calculated using the standardized mean difference (SMD) and its 95% CI. RESULTS The meta-analysis included 23 studies (5406 participants in total) and showed that mHealth interventions significantly improved QoL in patients with CHD (SMD 0.49, 95% CI 0.25-0.72; Z=4.07; P<.001) as well as relieved their anxiety (SMD -0.46, 95% CI -0.83 to -0.08; Z=2.38; P=.02) and depression (SMD -0.34, 95% CI -0.56 to -0.12; Z=3.00; P=.003) compared to usual care. The subgroup analyses indicated a significant effect favoring the mHealth intervention on reducing anxiety and depressive symptoms compared to usual care, especially when (1) the intervention duration was ≥6 months (P=.04 and P=.001), (2) the mHealth intervention was a simple one (only 1 mHealth intervention was used) (P=.01 and P<.001), (3) it was implemented during the COVID-19 pandemic (P=.04 and P=.01), (4) it was implemented in low- or middle-income countries (P=.01 and P=.02), (5) the intervention focused on mental health (P=.01 and P=.007), and (6) adherence rates were high (≥90%; P=.03 and P=.002). In addition, comparing mHealth interventions to usual care, there was an improvement in QoL when (1) the mHealth intervention was a simple one (P<.001), (2) it was implemented in low- or middle-income countries (P<.001), and (3) the intervention focused on mental health (P<.001). CONCLUSIONS On the basis of the existing evidence, mHealth interventions might be effective in improving QoL and reducing anxiety and depression in patients with CHD. However, large sample, high-quality, and rigorously designed randomized controlled trials are needed to provide further evidence. TRIAL REGISTRATION PROSPERO CRD42022383858; https://tinyurl.com/3ea2npxf.
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Affiliation(s)
- Qiao Ling Hou
- School of Nursing, Capital Medical University, Beijing, China
| | - Le Yang Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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Nelson AJ, Pagidipati NJ, Bosworth HB. Improving medication adherence in cardiovascular disease. Nat Rev Cardiol 2024; 21:417-429. [PMID: 38172243 DOI: 10.1038/s41569-023-00972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Non-adherence to medication is a global health problem with far-reaching individual-level and population-level consequences but remains unappreciated and under-addressed in the clinical setting. With increasing comorbidity and polypharmacy as well as an ageing population, cardiovascular disease and medication non-adherence are likely to become increasingly prevalent. Multiple methods for detecting non-adherence exist but are imperfect, and, despite emerging technology, a gold standard remains elusive. Non-adherence to medication is dynamic and often has multiple causes, particularly in the context of cardiovascular disease, which tends to require lifelong medication to control symptoms and risk factors in order to prevent disease progression. In this Review, we identify the causes of medication non-adherence and summarize interventions that have been proven in randomized clinical trials to be effective in improving adherence. Practical solutions and areas for future research are also proposed.
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Affiliation(s)
- Adam J Nelson
- Victorian Heart Institute, Melbourne, Victoria, Australia
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | - Hayden B Bosworth
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.
- Population Health Sciences, Duke University, Durham, NC, USA.
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Redfern J, Singleton AC, Raeside R, Santo K, Hafiz N, Spencer L, Leung RW, Roberts M, King M, Cho JG, Carr B, Jenkins C, Partridge SR, Hayes A, Chow CK, Hyun K. Integrated Text Messaging (ITM) for people attending cardiac and pulmonary rehabilitation: A multicentre randomised controlled trial. Ann Phys Rehabil Med 2024; 67:101800. [PMID: 38118248 DOI: 10.1016/j.rehab.2023.101800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/29/2023] [Accepted: 10/17/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND People living with cardiac and respiratory disease require improved post-hospital support that is readily available and efficient. OBJECTIVES To 1) test the effectiveness of an automated, semi-personalised text message support program on clinical and lifestyle outcomes amongst people attending cardiac and pulmonary rehabilitation. Also, 2) to evaluate the program's acceptability and utility using patient-reported outcome and experience measures. METHODS Multicentre randomised controlled trial (3:1, intervention:control) amongst cardiac and pulmonary rehabilitation attendees. Control received usual care (no message program). Intervention also received a 6-month text message lifestyle and support program. Primary outcome was 6-minute walk distance (6MWD). Secondary outcomes included clinical measures, lifestyle, patient-reported outcome and experience measures, medication adherence and rehabilitation attendance. RESULTS A total of 316 participants were recruited. They had a mean age of 66.7 (SD 10.1) years. Sixty percent were male (190/316) and 156 were cardiac rehabilitation participants. The cohort's mean baseline 6MWD was higher in the intervention than the control group. At 6 months, 6MWD improved in both groups; it was significantly greater amongst intervention than control participants (unadjusted mean difference of 43.4 m, 95 % CI 4.3 to 82.4; P = 0.0296). After adjustment for baseline values, there was no significant difference between intervention and control groups for 6MWD (adjusted mean difference 2.2 m, -21.2 to 25.6; P = 0·85), medication adherence, or cardiovascular risk factors. At 6-month follow-up, intervention participants reported significantly lower depression scores (adjusted mean difference -1.3, 95 % CI -2.2 to -0.3; P = 0.0124) and CAT scores (adjusted mean difference -3.9, 95 % CI -6.6 to -1.3; P = 0.0038), and significantly lower anxiety (adjusted mean difference -1.1, 95 %CI -2.1 to 0; P = 0.0456). Most participants (86 %) read most of their messages and strongly/agreed that the intervention was easy to understand (99 %) and useful (86 %). CONCLUSIONS An educational and supportive text message program for cardiac and pulmonary rehabilitation attendees improved anxiety and depression plus program attendance. The program was acceptable to, and useful for, participants and would be suitable for implementation alongside rehabilitation programs. TRIAL REGISTRATION NUMBER ACTRN12616001167459.
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Affiliation(s)
- Julie Redfern
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Charles Perkins Centre, University of Sydney; The George Institute for Global Health, University of New South Wales, NSW, Australia.
| | - Anna C Singleton
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Rebecca Raeside
- MPH, Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Karla Santo
- Hospital Israelita Albert Einstein, Academic Research Organization, São Paulo, Brazil; The George Institute for Global Health, University of New South Wales, NSW, Australia
| | - Nashid Hafiz
- MIPH, Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Lissa Spencer
- PhD, Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - Regina Wm Leung
- PhD, Department of Thoracic Medicine, Concord Repatriation General Hospital, Sydney Local Health District, NSW, Australia
| | - Mary Roberts
- MPal Care, Department of Respiratory and Sleep Medicine, Westmead Hospital, Western Sydney Local Health District, NSW, Australia; Faculty of Medicine and Health, The University of Sydney at Westmead Hospital, NSW, Australia
| | - Meredith King
- B Physiotherapy, Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, NSW, Australia
| | - Jin-Gun Cho
- PhD, Department of Respiratory and Sleep Medicine, Westmead Hospital, NSW, Australia; Faculty of Medicine and Health, University of Sydney at Westmead Hospital, Australia
| | - Bridie Carr
- BA Comms, NSW Agency for Clinical Innovation, NSW, Australia
| | - Christine Jenkins
- PhD, The George Institute for Global Health, Sydney and UNSW Faculty of Medicine and Health, NSW, Australia
| | - Stephanie R Partridge
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Charles Perkins Centre, University of Sydney, Australia
| | - Alison Hayes
- PhD, School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Clara K Chow
- PhD, Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney; Western Sydney Local Health District; The George Institute for Global Health, University of New South Wales, NSW, Australia
| | - Karice Hyun
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Department of Cardiology, Concord Repatriation General Hospital, Sydney Local Health District, NSW, Australia
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Campos Cervera LV, Sabouret P, Bernardi M, Spadafora L, Banach M, Muñoz F, Viruel M, Zaidel EJ, Bonorino J, Perez G, Arbucci R, Costabel JP. Treatment adherence in patients without ST-elevation acute coronary syndrome. Minerva Cardiol Angiol 2024; 72:134-140. [PMID: 37405714 DOI: 10.23736/s2724-5683.23.06345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Despite progress during the last decades, patients with coronary artery disease (CAD) remain with a high residual risk due to multiple reasons. Optimal medical treatment (OMT) provides a decrease of recurrent ischemic events after acute coronary syndrome (ACS). Therefore, treatment adherence results crucial to reduce further outcomes after the index event. No recent data are available in Argentinian population; the main objective of our study was to evaluate the adherence at 6 and 15 months in post non-ST elevation acute coronary syndrome (NST-ACS) consecutive patients. Secondary objective was to evaluate the relationship of adherence with 15-month events. METHODS A prespecified sub-analysis in the prospective registry Buenos Aires I was performed. The adherence was evaluated using the modified Morisky-Green Scale. RESULTS A number of 872 patients had information about adherence profile. Of them 76.4% were classified as adherents at month 6 and 83.6% at 15 (P=0.06). We did not find any difference in baseline characteristic between the adherent and non-adherent patients at 6 months. The adjusted analysis showed that non-adherent patients had a rate of ischemic events at 15th month of 20% (27/135) vs. 11.5% (52/452) in adherent patients (P=0.001). The bleeding events defined were of 3.6% in the non-adherent group vs. 5% in the adherent group without a statistical difference (P=0.238). CONCLUSIONS Adherence to treatment is still a major issue as almost 25% of patients should be considered as non-adherent to OMT. No clinical predictor of this phenomenon was identified but our criteria were not exhaustive. Good adherence to treatment was highly associated to a reduction of ischemic events, whereas no impact on bleeding events was found. These data support a better network and collaboration with shared decision between healthcare professionals with patients and family members to improve acceptance and adherence to optimal medical strategies.
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Affiliation(s)
- Lucía V Campos Cervera
- Unit of Cardiology, Department of Cardiology, Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina
| | - Pierre Sabouret
- Heart Institute and Action Group, Pitié-Salpétrière, Sorbonne University, Paris, France
| | - Marco Bernardi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Luigi Spadafora
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Rome, Italy
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University od Lodz, Lodz, Poland
| | - Florencia Muñoz
- Unit of Cardiology, Department of Cardiology, Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina
| | - Marcos Viruel
- Unit of Cardiology, Department of Cardiology, Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina
| | | | - José Bonorino
- Department of Cardiology, Hospital Austral, Buenos Aires, Argentina
| | - Gonzalo Perez
- Department of Cardiology, Clinica Olivos, Buenos Aires, Argentina
| | - Rosina Arbucci
- Unit of Cardiology, Department of Cardiology, Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina
| | - Juan P Costabel
- Unit of Cardiology, Department of Cardiology, Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina -
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Redfern J, Tu Q, Hyun K, Hollings MA, Hafiz N, Zwack C, Free C, Perel P, Chow CK. Mobile phone text messaging for medication adherence in secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2024; 3:CD011851. [PMID: 38533994 PMCID: PMC10966941 DOI: 10.1002/14651858.cd011851.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the leading cause of death globally, accounting for almost 18 million deaths annually. People with CVDs have a five times greater chance of suffering a recurrent cardiovascular event than people without known CVDs. Although drug interventions have been shown to be cost-effective in reducing the risk of recurrent cardiovascular events, adherence to medication remains suboptimal. As a scalable and cost-effective approach, mobile phone text messaging presents an opportunity to convey health information, deliver electronic reminders, and encourage behaviour change. However, it is uncertain whether text messaging can improve medication adherence and clinical outcomes. This is an update of a Cochrane review published in 2017. OBJECTIVES To evaluate the benefits and harms of mobile phone text messaging for improving medication adherence in people with CVDs compared to usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases, and two trial registers. We also checked the reference lists of all primary included studies and relevant systematic reviews and meta-analyses. The date of the latest search was 30 August 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) with participants with established arterial occlusive events. We included trials investigating interventions using short message service (SMS) or multimedia messaging service (MMS) with the aim of improving adherence to medication for the secondary prevention of cardiovascular events. The comparator was usual care. We excluded cluster-RCTs and quasi-RCTs. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were medication adherence, fatal cardiovascular events, non-fatal cardiovascular events, and combined CVD event. Secondary outcomes were low-density lipoprotein cholesterol for the effect of statins, blood pressure for antihypertensive drugs, heart rate for the effect of beta-blockers, urinary 11-dehydrothromboxane B2 for the antiplatelet effects of aspirin, adverse effects, and patient-reported experience. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 18 RCTs involving a total of 8136 participants with CVDs. We identified 11 new studies in the review update and seven studies in the previous version of the review. Participants had various CVDs including acute coronary syndrome, coronary heart disease, stroke, myocardial infarction, and angina. All studies were conducted in middle- and high-income countries, with no studies conducted in low-income countries. The mean age of participants was 53 to 64 years. Participants were recruited from hospitals or cardiac rehabilitation facilities. Follow-up ranged from one to 12 months. There was variation in the characteristics of text messages amongst studies (e.g. delivery method, frequency, theoretical grounding, content used, personalisation, and directionality). The content of text messages varied across studies, but generally included medication reminders and healthy lifestyle information such as diet, physical activity, and weight loss. Text messages offered advice, motivation, social support, and health education to promote behaviour changes and regular medication-taking. We assessed risk of bias for all studies as high, as all studies had at least one domain at unclear or high risk of bias. Medication adherence Due to different evaluation score systems and inconsistent definitions applied for the measurement of medication adherence, we did not conduct meta-analysis for medication adherence. Ten out of 18 studies showed a beneficial effect of mobile phone text messaging for medication adherence compared to usual care, whereas the other eight studies showed either a reduction or no difference in medication adherence with text messaging compared to usual care. Overall, the evidence is very uncertain about the effects of mobile phone text messaging for medication adherence when compared to usual care. Fatal cardiovascular events Text messaging may have little to no effect on fatal cardiovascular events compared to usual care (odds ratio 0.83, 95% confidence interval (CI) 0.47 to 1.45; 4 studies, 1654 participants; low-certainty evidence). Non-fatal cardiovascular events We found very low-certainty evidence that text messaging may have little to no effect on non-fatal cardiovascular events. Two studies reported non-fatal cardiovascular events, neither of which found evidence of a difference between groups. Combined CVD events We found very low-certainty evidence that text messaging may have little to no effect on combined CVD events. Only one study reported combined CVD events, and did not find evidence of a difference between groups. Low-density lipoprotein cholesterol Text messaging may have little to no effect on low-density lipoprotein cholesterol compared to usual care (mean difference (MD) -1.79 mg/dL, 95% CI -4.71 to 1.12; 8 studies, 4983 participants; very low-certainty evidence). Blood pressure Text messaging may have little to no effect on systolic blood pressure (MD -0.93 mmHg, 95% CI -3.55 to 1.69; 8 studies, 5173 participants; very low-certainty evidence) and diastolic blood pressure (MD -1.00 mmHg, 95% CI -2.49 to 0.50; 5 studies, 3137 participants; very low-certainty evidence) when compared to usual care. Heart rate Text messaging may have little to no effect on heart rate compared to usual care (MD -0.46 beats per minute, 95% CI -1.74 to 0.82; 4 studies, 2946 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Due to limited evidence, we are uncertain if text messaging reduces medication adherence, fatal and non-fatal cardiovascular events, and combined cardiovascular events in people with cardiovascular diseases when compared to usual care. Furthermore, text messaging may result in little or no effect on low-density lipoprotein cholesterol, blood pressure, and heart rate compared to usual care. The included studies were of low methodological quality, and no studies assessed the effects of text messaging in low-income countries or beyond the 12-month follow-up. Long-term and high-quality randomised trials are needed, particularly in low-income countries.
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Affiliation(s)
- Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Sydney , Australia
| | - Qiang Tu
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Cardiology, Concord Hospital, Sydney , Australia
| | - Matthew A Hollings
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nashid Hafiz
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Clara Zwack
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Pablo Perel
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
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Sim HW, Koh KWL, Poh SC, Chan SP, Marchesseau S, Singh D, Han Y, Ng F, Lim E, Prabath JF, Lee CH, Chen R, Carvalho L, Tan SH, Loh JPY, Tan JWC, Kuwelker K, Amanullah RM, Chin CT, Yip JWL, Lee CY, Gan J, Lo CY, Ho HH, Hausenloy DJ, Tai BC, Richards AM, Chan MY. Remote intensive management to improve antiplatelet adherence in acute myocardial infarction: a secondary analysis of the randomized controlled IMMACULATE trial. J Thromb Thrombolysis 2024; 57:408-417. [PMID: 38300500 DOI: 10.1007/s11239-023-02931-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 02/02/2024]
Abstract
This study aim to investigate if remote intensive coaching for the first 6 months post-AMI will improve adherence to the twice-a-day antiplatelet medication, ticagrelor. Between July 8, 2015, to March 29, 2019, AMI patients were randomly assigned to remote intensive management (RIM) or standard care (SC). RIM participants underwent 6 months of weekly then two-weekly consultations to review medication side effects and medication adherence coaching by a centralized nurse practitioner team, whereas SC participants received usual cardiologist face-to-face consultations. Adherence to ticagrelor were determined using pill counting and serial platelet reactivity measurements for 12 months. A total of 149 (49.5%) of participants were randomized to RIM and 152 (50.5%) to SC. Adherence to ticagrelor was similar between RIM and SC group at 1 month (94.4 ± 0.7% vs. 93.6±14.7%, p = 0.537), 6 months (91.0±14.6% vs. 90.6±14.8%, p = 0.832) and 12 months (87.4±17.0% vs. 89.8±12.5%, p = 0.688). There was also no significant difference in platelet reactivity between the RIM and SC groups at 1 month (251AU*min [212-328] vs. 267AU*min [208-351], p = 0.399), 6 months (239AU*min [165-308] vs. 235AU*min [171-346], p = 0.610) and 12 months (249AU*min [177-432] vs. 259AU*min [182-360], p = 0.678). Sensitivity analysis did not demonstrate any association of ticagrelor adherence with bleeding events and major adverse cardiovascular events. RIM, comprising 6 months of intensive coaching by nurse practitioners, did not improve adherence to the twice-a-day medication ticagrelor compared with SC among patients with AMI. A gradual decline in ticagrelor adherence over 12 months was observed despite 6 months of intensive coaching.
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Affiliation(s)
- Hui Wen Sim
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.
- Department of Medicine, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore.
| | - Karen W L Koh
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Sock-Cheng Poh
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Siew Pang Chan
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Stephanie Marchesseau
- Clinical Imaging Research Centre, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Devinder Singh
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Yiying Han
- Clinical Imaging Research Centre, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
| | - Faclin Ng
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Eleanor Lim
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Joseph F Prabath
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Ruth Chen
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Leonardo Carvalho
- Universidade Federal de São Paulo, R. Sena Madureira, 1500 - Vila Clementino, São Paulo, SP, 04021-001, Brazil
| | - Sock-Hwee Tan
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Joshua P Y Loh
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Jack W C Tan
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
| | - Karishma Kuwelker
- Betanien Hospital, Bjørnstjerne Bjørnsons gate 6, Skien, 3722, Norway
| | - R M Amanullah
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
| | - Chee-Tang Chin
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
| | - James W L Yip
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Choy-Yee Lee
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Juvena Gan
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Chew-Yong Lo
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
| | - Hee-Hwa Ho
- Department of Cardiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Derek J Hausenloy
- National Heart Centre Singapore, 5 Hospital Dr, Singapore, 169609, Singapore
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Bee-Choo Tai
- Saw Swee Hock School of Public Health, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - A Mark Richards
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
- Christchurch Heart Institute, University of Otago, 362 Leith Street, Dunedin North, Dunedin, 9016, New Zealand
| | - Mark Y Chan
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.
- Department of Medicine, Yong Loo-Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228, Singapore.
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Höppchen I, Wurhofer D, Meschtscherjakov A, Smeddinck JD, Kulnik ST. Targeting behavioral factors with digital health and shared decision-making to promote cardiac rehabilitation-a narrative review. Front Digit Health 2024; 6:1324544. [PMID: 38463944 PMCID: PMC10920294 DOI: 10.3389/fdgth.2024.1324544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Cardiac rehabilitation (CR) represents an important steppingstone for many cardiac patients into a more heart-healthy lifestyle to prevent premature death and improve quality of life years. However, CR is underutilized worldwide. In order to support the development of targeted digital health interventions, this narrative review (I) provides understandings of factors influencing CR utilization from a behavioral perspective, (II) discusses the potential of digital health technologies (DHTs) to address barriers and reinforce facilitators to CR, and (III) outlines how DHTs could incorporate shared decision-making to support CR utilization. A narrative search of reviews in Web of Science and PubMed was conducted to summarize evidence on factors influencing CR utilization. The factors were grouped according to the Behaviour Change Wheel. Patients' Capability for participating in CR is influenced by their disease knowledge, awareness of the benefits of CR, information received, and interactions with healthcare professionals (HCP). The Opportunity to attend CR is impacted by healthcare system factors such as referral processes and HCPs' awareness, as well as personal resources including logistical challenges and comorbidities. Patients' Motivation to engage in CR is affected by emotions, factors such as gender, age, self-perception of fitness and control over the cardiac condition, as well as peer comparisons. Based on behavioral factors, this review identified intervention functions that could support an increase of CR uptake: Future DHTs aiming to support CR utilization may benefit from incorporating information for patients and HCP education, enabling disease management and collaboration along the patient pathway, and enhancing social support from relatives and peers. To conclude, considerations are made how future innovations could incorporate such functions.
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Affiliation(s)
- Isabel Höppchen
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- Department of Artificial Intelligence and Human Interfaces, Human Computer Interaction Division, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Daniela Wurhofer
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Alexander Meschtscherjakov
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- Department of Artificial Intelligence and Human Interfaces, Human Computer Interaction Division, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Jan David Smeddinck
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Stefan Tino Kulnik
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
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Mansurova JA, Orekhov A, Zhunuspekova AS, Kassymova AA, Karazhanova LK. The Impact of Patient Adherence to Dual Antiplatelet Medication Following Percutaneous Coronary Intervention on the Occurrence of Adverse Cardiovascular Events. Patient Prefer Adherence 2024; 18:425-434. [PMID: 38384448 PMCID: PMC10880456 DOI: 10.2147/ppa.s450317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/03/2024] [Indexed: 02/23/2024] Open
Abstract
Background The objective of this study is to examine the impact of medication adherence on the timing of non-cardiovascular serious events (NCDS) onset in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods This prospective study was conducted at a single center and involved 220 ACS patients who underwent sequential PCI with stenting. The Morisky Green Levine Medication Adherence Scale was employed to assess adherence to dual antiplatelet therapy (DAPT) and its impact on NCDS occurrence. Early in their hospitalization, all patients received education at the Coronary Heart Disease School. The survival rates of patients in both the main group and a control group (n=355) were subsequently evaluated. Results The study findings indicated an inverse relationship between stent thrombosis development (Rho=-0.334; p=0.001) and the timing of recurrent myocardial ischemia. There was also an inverse correlation between patient adherence and stent thrombosis development (Rho=-0.275; p=0.009). Non-adherent individuals had a 16.8 times higher likelihood of experiencing stent thrombosis compared to compliant patients (p<0.001). Following participation in the CHD School program, treatment adherence increased from 56.5% to 88.2%. Education for ACS patients post-stenting was significantly associated with all-cause mortality within the first 6 months (p=0.040). Conclusion Secondary preventive measures, including education, impact the success of endovascular interventions in both the early hospital phase and the long term. Patient education can serve as a supplementary intervention to enhance DAPT adherence, thus diminishing the risk of recurrent cardiovascular events and mortality post endovascular intervention.
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Affiliation(s)
- J A Mansurova
- Department of Therapy, Non-Commercial Joint-Stock Company “Semey Medical University”, Semey, The Republic of Kazakhstan
| | - Andrey Orekhov
- Department of Therapy, Non-Commercial Joint-Stock Company “Semey Medical University”, Semey, The Republic of Kazakhstan
| | - A S Zhunuspekova
- Department of Therapy, Non-Commercial Joint-Stock Company “Semey Medical University”, Semey, The Republic of Kazakhstan
| | - A A Kassymova
- Department of Therapy, Non-Commercial Joint-Stock Company “Semey Medical University”, Semey, The Republic of Kazakhstan
| | - L K Karazhanova
- Department of Therapy, Non-Commercial Joint-Stock Company “Semey Medical University”, Semey, The Republic of Kazakhstan
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Akamine A, Nagasaki Y, Tomizawa A, Otori K. Risk Factors for Non-Adherence to Pharmacist or Non-Pharmacist Explanations on Preoperative Medication Discontinuation: A Retrospective Japanese Study. Patient Prefer Adherence 2024; 18:255-266. [PMID: 38313826 PMCID: PMC10838503 DOI: 10.2147/ppa.s445474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/20/2024] [Indexed: 02/06/2024] Open
Abstract
Purpose The risk factors for non-adherence to pharmacist or non-pharmacist explanations of preoperative medication discontinuation are unknown. The primary outcome of this study was to determine whether the final explainer's occupation was a risk factor for non-adherence. The secondary outcomes were to determine the risk factors for non-adherence after limiting the departments or adjusting for age. Patients and Methods We retrospectively examined the data (including patient age, sex, prescription medications, comorbidities, presence of roommate, and number of days between receiving explanation and surgery) of 1132 patients on medications that could affect surgery at a Japanese university hospital between April 1, 2017, and March 31, 2020. The primary endpoint was whether the occupation of the last person explaining medication discontinuation to the patient was an independent risk factor for non-adherence (age ≥65 years vs <65 years). Secondary endpoints included subgroup analyses in urological, gastrointestinal, and otolaryngological areas, as well as a sensitivity analysis (age as a continuous variable) to confirm the validity of the primary endpoint results. A multivariate binary logistic regression identified independent non-adherence risk factors. Results The main analysis showed that discontinuing two or more medications was a risk factor for non-adherence (adjusted odds ratio (AOR): 1.67; 95% confidence interval (CI): 1.13-2.47; p = 0.01). However, in analyses coordinated by department (urological, gastrointestinal, and otolaryngological), ≥65 (versus <65) years of age was determined as a risk factor for increased nonadherence (AOR: 2.27, 95% CI: 1.11-4.63; p=0.024). Age-adjusted analysis (continuous variables) showed similar results to the primary endpoint (AOR: 1.68, 95% CI: 1.14-2.49, p = 0.009). Conclusion Two or more medications, and not the final explainer's occupation, were associated with pre-surgery medication non-adherence. To prevent non-adherence, pharmacists and non-pharmacists should educate patients about preoperative medication discontinuation. These findings could help identify high-risk non-adherence patients.
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Affiliation(s)
| | - Yuya Nagasaki
- Department of Pharmacy, Kitasato University Hospital, Kanagawa, Japan
| | - Atsushi Tomizawa
- Department of Pharmacy, Kitasato University Hospital, Kanagawa, Japan
| | - Katsuya Otori
- Department of Pharmacy, Kitasato University Hospital, Kanagawa, Japan
- Research and Education Center for Clinical Pharmacy, Division of Clinical Pharmacy, Laboratory of Pharmacy Practice and Science 1, Kitasato University School of Pharmacy, Tokyo, Japan
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Fakes K, Hobden B, Zwar N, Collins N, Oldmeadow C, Paolucci F, Davies A, Fernando I, McGee M, Williams T, Robson C, Hungerford R, Ooi JY, Sverdlov AL, Sanson-Fisher R, Boyle AJ. Investigating the effect of an online enhanced care program on the emotional and physical wellbeing of patients discharged from hospital with acute decompensated heart failure: Study protocol for a randomised controlled trial: Enhanced care program for heart failure. Digit Health 2024; 10:20552076241256503. [PMID: 38817841 PMCID: PMC11138184 DOI: 10.1177/20552076241256503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
Objective Depression is highly prevalent and associated with increased hospitalisations and mortality among patients with heart failure (HF). This study will evaluate the effectiveness and cost-effectiveness of an online wellbeing program for patients discharged from hospital with acute decompensated heart failure (ADHF) in (i) improving emotional and physical wellbeing, and (ii) decreasing healthcare utilisation. Methods Two-arm randomised controlled trial. Eligible patients with ADHF will be recruited pre-discharge from two hospitals. Five hundred and seventy participants will be randomised to receive the intervention (online enhanced care program for HF: 'Enhanced HF Care') or usual care. Enhanced HF Care includes health education (11 micro-learning modules) and monitoring of depression and clinical outcomes via fortnightly/monthly surveys for 6 months, with participants offered tailored advice via video email and SMS. Cardiac nurses track real-time patient data from a dashboard and receive automated email alerts when patients report medium- or high-risk levels of depression or clinical symptoms, to action where needed. General practitioners also receive automated alerts if patients report medium- or high-risk survey responses and are encouraged to schedule a patient consultation. Results Sixty-five participants enrolled to-date. Co-primary outcomes ('Minnesota Living with Heart Failure Questionnaire' Emotional and Physical subscales) and healthcare utilisation (secondary outcome) at 1- and 6-month post-recruitment will be compared between treatment arms using linear mixed effects regression models. Conclusions This study has the potential to reduce the burden of depression for patients with HF by prioritising urgent mental health needs and clinical symptoms while simultaneously empowering patients with self-care knowledge. Trial registration The trial was prospectively registered via the Australian New Zealand Clinical Trials Registry: ACTRN12622001289707. Issue date: 4 October 2022.
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Affiliation(s)
- Kristy Fakes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Breanne Hobden
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Nick Zwar
- Bond University, Faculty of Health Sciences and Medicine, Robina, Queensland, Australia
| | - Nick Collins
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- Newcastle Business School, University of Newcastle, Callaghan, New South Wales, Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Francesco Paolucci
- Newcastle Business School, University of Newcastle, Callaghan, New South Wales, Australia
- Department of Sociology, Law and Economics, University of Bologna Bologna BO, Italy
| | - Allan Davies
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Irosh Fernando
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Newcastle Mental Health Service, Hunter New England Local Area Health District, New South Wales, Newcastle, Australia
| | - Michael McGee
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Cardiac Department, Tamworth Rural Referral Hospital, North Tamworth New South Wales, Australia
| | - Trent Williams
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Cameron Robson
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Robert Hungerford
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jia Ying Ooi
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Aaron L Sverdlov
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Andrew J Boyle
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Cardiovascular Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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Fácila Rubio L, Lozano-Granero C, Vidal-Pérez R, Barrios V, Freixa-Pamias R. New technologies for the diagnosis, treatment, and monitoring of cardiovascular diseases. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:88-96. [PMID: 37838182 DOI: 10.1016/j.rec.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/20/2023] [Indexed: 10/16/2023]
Abstract
Telemedicine enables the remote provision of medical care through information and communication technologies, facilitating data transmission, patient participation, promotion of heart-healthy habits, diagnosis, early detection of acute decompensation, and monitoring and follow-up of cardiovascular diseases. Wearable devices have multiple clinical applications, ranging from arrhythmia detection to remote monitoring of chronic diseases and risk factors. Integrating these technologies safely and effectively into routine clinical practice will require a multidisciplinary approach. Technological advances and data management will increase telemonitoring strategies, which will allow greater accessibility and equity, as well as more efficient and accurate patient care. However, there are still unresolved issues, such as identifying the most appropriate technological infrastructure, integrating these data into medical records, and addressing the digital divide, which can hamper patients' adoption of remote care. This article provides an updated overview of digital tools for a more comprehensive approach to atrial fibrillation, heart failure, risk factors, and treatment adherence.
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Affiliation(s)
- Lorenzo Fácila Rubio
- Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Universitat de València, Valencia, Spain.
| | - Cristina Lozano-Granero
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal y Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rafael Vidal-Pérez
- Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (UAH), Madrid, Spain
| | - Román Freixa-Pamias
- Servicio de Cardiología, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
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Cruz-Cobo C, Bernal-Jiménez MÁ, Calle-Pérez G, Gheorghe L, Gutiérrez-Barrios A, Cañadas-Pruaño D, Rodríguez-Martín A, Tur JA, Vázquez-García R, Santi-Cano MJ. Impact of mHealth application on adherence to cardiac rehabilitation guidelines after a coronary event: Randomised controlled clinical trial protocol. Digit Health 2024; 10:20552076241234474. [PMID: 38510574 PMCID: PMC10953095 DOI: 10.1177/20552076241234474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 01/25/2024] [Indexed: 03/22/2024] Open
Abstract
Background Coronary disease is the main cause of death around the world. mHealth technology is considered attractive and promising to promote behavioural changes aimed at healthy lifestyle habits among coronary patients. The purpose of this study is to evaluate the efficacy of an mHealth intervention regarding improved results in secondary prevention in patients after an acute myocardial infarction (AMI) or angina in terms of lifestyle, clinical variables and therapeutic compliance. Methods Randomised clinical trial with 300 patients who underwent a percutaneous coronary intervention (PCI) with stent implant. They will be assigned to either the mHealth group, subject to a self-monitored educational intervention involving an internet application installed on their mobile phone or tablet, or to a control group receiving standard healthcare (150 patients in each arm). The primary outcome variables will be adherence to the Mediterranean diet, physical activity, smoking, therapeutic compliance, knowledge acquired, user-friendliness and satisfaction with the application. Measurements of blood pressure, heart rate, body weight, waist circumference (WC) and the 6-min walk test will be taken. Furthermore, the blood lipid profile, glucose and HbA1c will be evaluated. Clinical interview will be conducted, and validated questionnaires completed. The primary quantitative results will be compared using an analysis of covariance adjusted for age and sex. A multivariate analysis will be performed to examine the association of the intervention with lifestyle habits, the control of cardiovascular risk factors (CDRFs) and the results after the hospital discharge (major adverse events, treatment compliance and lifestyle). Conclusions The study will provide evidence about the effectiveness of an mHealth intervention at improving the lifestyle of the participants and could be offered to patients with coronary disease to complement existing services. Trial registration NCT05247606. [https://ClinicalTrials.gov]. 21/02/2022.
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Affiliation(s)
- Celia Cruz-Cobo
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
- Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - María Ángeles Bernal-Jiménez
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
- Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - Germán Calle-Pérez
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
- Clinical Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Livia Gheorghe
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
- Clinical Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Alejandro Gutiérrez-Barrios
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
- Clinical Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Dolores Cañadas-Pruaño
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
- Clinical Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Amelia Rodríguez-Martín
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Biomedicine, Biotechnology, and Public Health Department, University of Cadiz, Cádiz, Spain
| | - Josep A Tur
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands-IUNICS, IDISBA & CIBEROBN, Palma de Mallorca, Spain
| | - Rafael Vázquez-García
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
- Clinical Cardiology Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - María José Santi-Cano
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz (INiBICA), Cádiz, Spain
- Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
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Beckie TM, Sengupta A, Dey AK, Dutta K, Ji M, Chellappan S. A Mobile Health Behavior Change Intervention for Women With Coronary Heart Disease: A RANDOMIZED CONTROLLED PILOT STUDY. J Cardiopulm Rehabil Prev 2024; 44:40-48. [PMID: 37285601 DOI: 10.1097/hcr.0000000000000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE The aim of this study was to evaluate the effects of a mobile health (mHealth) intervention, HerBeat, compared with educational usual care (E-UC) for improving exercise capacity (EC) and other patient-reported outcomes at 3 mo among women with coronary heart disease. METHODS Women were randomized to the HerBeat group (n = 23), a behavior change mHealth intervention with a smartphone, smartwatch, and health coach or to the E-UC group (n = 24) who received a standardized cardiac rehabilitation workbook. The primary endpoint was EC measured with the 6-min walk test (6MWT). Secondary outcomes included cardiovascular disease risk factors and psychosocial well-being. RESULTS A total of 47 women (age 61.2 ± 9.1 yr) underwent randomization. The HerBeat group significantly improved on the 6MWT from baseline to 3 mo ( P = .016, d = .558) while the E-UC group did not ( P = .894, d =-0.030). The between-group difference of 38 m at 3 mo was not statistically significant. From baseline to 3 mo, the HerBeat group improved in anxiety ( P = .021), eating habits confidence ( P = .028), self-efficacy for managing chronic disease ( P = .001), diastolic blood pressure ( P = .03), general health perceptions ( P = .047), perceived bodily pain ( P = .02), and waist circumference ( P = .008) while the E-UC group showed no improvement on any outcomes. CONCLUSIONS The mHealth intervention led to improvements in EC and several secondary outcomes from baseline to 3 mo while the E-UC intervention did not. A larger study is required to detect small differences between groups. The implementation and outcomes evaluation of the HerBeat intervention was feasible and acceptable with minimal attrition.
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Affiliation(s)
- Theresa M Beckie
- College of Nursing, University of South Florida, Tampa, the United States (Drs Beckie and Ji); Business School, University of Queensland, Brisbane, Australia (Dr Sengupta); College of Engineering, University of South Florida, Tampa, the United States (Drs Dey and Chellappan); and College of Business, University of South Florida, Tampa, the United States (Dr Dutta)
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Bhagavathula AS, Aldhaleei WA, Atey TM, Assefa S, Tesfaye W. Efficacy of eHealth Technologies on Medication Adherence in Patients With Acute Coronary Syndrome: Systematic Review and Meta-Analysis. JMIR Cardio 2023; 7:e52697. [PMID: 38113072 PMCID: PMC10762619 DOI: 10.2196/52697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/06/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Suboptimal adherence to cardiac pharmacotherapy, recommended by the guidelines after acute coronary syndrome (ACS) has been recognized and is associated with adverse outcomes. Several randomized controlled trials (RCTs) have shown that eHealth technologies are useful in reducing cardiovascular risk factors. However, little is known about the effect of eHealth interventions on medication adherence in patients following ACS. OBJECTIVE The aim of this study is to examine the efficacy of the eHealth interventions on medication adherence to selected 5 cardioprotective medication classes in patients with ACS. METHODS A systematic literature search of PubMed, Embase, Scopus, and Web of Science was conducted between May and October 2022, with an update in October 2023 to identify RCTs that evaluated the effectiveness of eHealth technologies, including texting, smartphone apps, or web-based apps, to improve medication adherence in patients after ACS. The risk of bias was evaluated using the modified Cochrane risk-of-bias tool for RCTs. A pooled meta-analysis was performed using a fixed-effect Mantel-Haenszel model and assessed the medication adherence to the medications of statins, aspirin, P2Y12 inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and β-blockers. RESULTS We identified 5 RCTs, applicable to 4100 participants (2093 intervention vs 2007 control), for inclusion in the meta-analysis. In patients who recently had an ACS, compared to the control group, the use of eHealth intervention was not associated with improved adherence to statins at different time points (risk difference [RD] -0.01, 95% CI -0.03 to 0.03 at 6 months and RD -0.02, 95% CI -0.05 to 0.02 at 12 months), P2Y12 inhibitors (RD -0.01, 95% CI -0.04 to 0.02 and RD -0.01, 95% CI -0.03 to 0.02), aspirin (RD 0.00, 95% CI -0.06 to 0.07 and RD -0.00, 95% CI -0.07 to 0.06), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (RD -0.01, 95% CI -0.04 to 0.02 and RD 0.01, 95% CI -0.04 to 0.05), and β-blockers (RD 0.00, 95% CI -0.03 to 0.03 and RD -0.01, 95% CI -0.05 to 0.03). The intervention was also not associated with improved adherence irrespective of the adherence assessment method used (self-report or objective). CONCLUSIONS This review identified limited evidence on the effectiveness of eHealth interventions on adherence to guideline-recommended medications after ACS. While the pooled analyses suggested a lack of effectiveness of such interventions on adherence improvement, further studies are warranted to better understand the role of different eHealth approaches in the post-ACS context.
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Affiliation(s)
- Akshaya Srikanth Bhagavathula
- Department of Public Health, College of Health and Human Services, North Dakota State University, Fargo, ND, United States
| | - Wafa Ali Aldhaleei
- Gastroenterology and Hepatology Department, Mayo Clinic, Jacksonville, FL, United States
| | - Tesfay Mehari Atey
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Solomon Assefa
- Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wubshet Tesfaye
- Sydney Pharmacy School, The University of Sydney, NSW, Australia
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15
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Zou H, Chair SY, Luo D, Liu Q, Wang XQ, Yang BX. A mindfulness-oriented psycho-behavioral intervention for patients with acute coronary syndrome: A pilot study. Heart Lung 2023; 62:240-248. [PMID: 37611384 DOI: 10.1016/j.hrtlng.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND People frequently experience physical and psychological challenges (e.g., depression and anxiety) and high risk of poor prognosis after an acute coronary event. Mindfulness-based intervention holds promise as an effective approach to promoting health and well-being. OBJECTIVES To explore the feasibility, acceptability, and potential effects on psychological distress, cardiovascular risk factors and health-related quality of life of a mindfulness-oriented psycho-behavioral intervention for patients with acute coronary syndrome. METHODS We conducted a pilot randomized controlled trial to test the feasibility, acceptability and potential effects of the intervention in 50 patients with acute coronary syndrome. The intervention included six weekly sessions, including one face-to-face session and five WeChat-delivered sessions that incorporated mindfulness training with health education and lifestyle modification. Eligible patients were recruited in two public hospitals in China and randomly allocated into the intervention group (n = 25) or control group (n = 25). RESULTS Intervention feasibility was supported by a relatively high recruitment rate (66.7%) and retention rate (84%) and a smooth and brief data collection procedure (15 to 25 min) of the pilot study. Positive responses of the acceptability dichotomous scale ranged from 81% to 100%, suggesting the intervention was generally acceptable. The intervention had a significant group × time effect on dietary behavior (B = 0.31,95% CI: 0.08, 0.54, P = 0.008) with an effect size (Cohen's d) of -0.72. CONCLUSIONS The mindfulness-oriented psycho-behavioral intervention appears to be feasible and acceptable and have a promising effect on dietary behavior in patients with acute coronary syndrome. A fully powered randomized controlled trial is warranted to further assess the efficacy of the intervention. TRIAL REGISTRATION Chinese Clinical Trial Registry, No., ChiCTR2000033526.
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Affiliation(s)
- Huijing Zou
- School of Nursing, Wuhan University, Building 2, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dan Luo
- School of Nursing, Wuhan University, Building 2, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Qian Liu
- School of Nursing, Wuhan University, Building 2, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Xiao Qin Wang
- School of Nursing, Wuhan University, Building 2, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China
| | - Bing Xiang Yang
- School of Nursing, Wuhan University, Building 2, No. 115 Donghu Road, Wuchang District, Wuhan 430071, China.
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16
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Bahit MC, Korjian S, Daaboul Y, Baron S, Bhatt DL, Kalayci A, Chi G, Nara P, Shaunik A, Gibson CM. Patient Adherence to Secondary Prevention Therapies After an Acute Coronary Syndrome: A Scoping Review. Clin Ther 2023; 45:1119-1126. [PMID: 37690915 DOI: 10.1016/j.clinthera.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE Adherence to guideline-recommended, long-term secondary preventative therapies among patients with acute coronary syndrome (ACS) is fundamental to improving long-term outcomes. The purpose of this scoping review was to provide a broad synopsis of pertinent studies in a structured and comprehensive way regarding factors that influence patient adherence to medical therapy after ACS. METHODS Relevant articles focusing on adherence to medical therapy after ACS were retrieved from the EMBASE and MEDLINE databases (search date, September 7, 2021). Studies were independently screened, and relevant information was extracted. FINDINGS A total of 58 studies were identified by using the EMBASE and MEDLINE databases. Adherence to secondary prevention was moderate to low and steadily decreased over time. Nearly 30% of patients discontinued one or more medications within 90 days of their primary ACS, and adherence decreased to 50% to 60% at 1 year postdischarge. There were no major differences in adherence between drug classes. Factors influencing patient adherence can be broadly divided into 3 categories: patient related, health care system related, and disease related. Patients managed with percutaneous coronary interventions were more adherent to follow-up treatment than medically managed patients. Depression was reported as a major psychological factor that negatively affected adherence. Improved adherence was observed when higher levels of patient education and provider engagement were delivered during postdischarge follow-up, particularly when scheduled early. Notably, the incidence of major adverse cardiovascular events was lower in hospitals with high 90-day medication adherence than those with moderate or low adherence. IMPLICATIONS Patient nonadherence to guideline-recommended long-term pharmacologic secondary preventative therapies after ACS is multifactorial. A comprehensive multifaceted approach should be implemented to improve adherence and clinical outcomes. This approach should include key interventions such as early follow-up visits, high medication adherence at 90 days, patient engagement and education, and development of novel interventions that support the 3 broad categories influencing patient adherence as discussed in this review.
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Affiliation(s)
| | - Serge Korjian
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Yazan Daaboul
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne Baron
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Deepak L Bhatt
- Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Arzu Kalayci
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerald Chi
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Nara
- CSL Behring, King of Prussia, Pennsylvania, USA
| | | | - C Michael Gibson
- PERFUSE Study Group, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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17
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Singleton AC, Raeside R, Hyun KK, Hayes M, Sherman KA, Elder E, Redfern J, Partridge SR. A National Health and Wellness SMS Text Message Program for Breast Cancer Survivors During COVID-19 (EMPOWER-SMS COVID-19): Mixed Methods Evaluation Using the RE-AIM Framework. J Med Internet Res 2023; 25:e45164. [PMID: 37490319 PMCID: PMC10410388 DOI: 10.2196/45164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND COVID-19 lockdowns caused widespread closures of supportive care services for breast cancer survivors in Australia. In a randomized controlled trial, our team's lifestyle-focused, evidence-based SMS text message support program (EMPOWER-SMS COVID-19) was found to be acceptable and useful for breast cancer survivors, and it was ready for rapid widespread delivery. OBJECTIVE This study aims to evaluate the reach (uptake) of an adapted 3-month lifestyle-focused SMS text message program (EMPOWER-SMS COVID-19) and barriers and enablers to implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. METHODS A mixed methods pre-post study was conducted to evaluate the EMPOWER-SMS COVID-19 program. The study evaluated the following aspects: (1) reach/representativeness, which refers to the proportion of participant enrollment (ie, number enrolled/number that visited the study website) and demographics (eg, age, sex, ethnicity, time since completing treatment, Index of Relative Socio-economic Advantage and Disadvantage [IRSAD; quintile 1, which refers to most disadvantaged areas, to quintile 5, which refers to least disadvantaged areas, and remoteness); (2) effectiveness, in which participant engagement and acceptability were evaluated using SMS text message reply data and a feedback survey (5-point Likert scale and free-text responses); (3) adoption, which corresponds to the proportion of organizations or health professionals who agreed to promote the program; (4) implementation fidelity and maintenance, which evaluated SMS text message delivery data, opt-outs, costs, and adaptations. Quantitative data were summarized using means and SDs or frequencies and percentages, while qualitative data were analyzed thematically. RESULTS With regard to the reach/representativeness of the program, 841/1340 (62.8%) participants enrolled and provided electronic consent. Participants had a mean age of 58.8 (SD 9.8; range 30-87) years. According to the data collected, most participants identified as female (837/840, 99.6%) and White (736/840, 87.6%) and nearly half (418/841, 49.7%) finished treatment ≤18 months ago. Most resided in major cities (574/838, 68.5%) and 30% (251/838) in IRSAD quintile 1 or 2. In terms of effectiveness, 852 replies were received from 511 unique participants (median 1; range 1-26). The most common replies were participants stating how they heard about the program (467/852, 54.8%) or "thank you" (131/852, 15.4%). None of the replies contained urgent safety concerns. Among participants who provided feedback (449/841, 53.4%), most "(strongly) agreed" the SMS text messages were easy to understand (445/448, 99.3%), useful (373/440, 84.8%), helped participants feel supported (388/448, 86.6%), and motivated participants to be physically active (312/445, 70.1%) and eat healthier (313/457, 68.5%). Free-text responses revealed 5 factors influencing engagement: (1) feeling supported and less alone, (2) motivation and reassurance for health self-management, (3) the variety of information, (4) weblinks to information and resources, and (5) the option to save the SMS text messages. Concerning adoption, 50% (18/36) of organizations/health professionals agreed to promote the program. With regard to implementation/maintenance, SMS text messages were delivered as planned (97.43% [41,257/42,344] of SMS text messages were successfully delivered) with minimal opt-outs (62/838, 7.4%) and low cost (Aus $15.40/participant; Aus $1=US $0.67). No adaptations were made during the intervention period. Postintervention adaptations included adding weblinks and participant-selected customizations. CONCLUSIONS EMPOWER-SMS COVID-19 was implemented quickly, had a broad reach, and had high engagement and acceptability among socioeconomically diverse participants. The program had high fidelity, low cost, and required minimal staff oversight, which may facilitate future implementation. However, further research is needed to evaluate barriers and enablers to adoption and implementation for health professionals and strategies for long-term maintenance.
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Affiliation(s)
- Anna C Singleton
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rebecca Raeside
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karice K Hyun
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Molly Hayes
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kerry A Sherman
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - Julie Redfern
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Research Education Network, Western Sydney Local Health District, Sydney, Australia
| | - Stephanie R Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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18
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Vigen R, Das SR. Raising the Bar for Implementation Science. Circulation 2023; 147:1515-1517. [PMID: 37186685 DOI: 10.1161/circulationaha.123.064671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Rebecca Vigen
- Division of Cardiology, Department of Medicine, University of Southwestern Medical Center, Dallas, TX (R.V., S.R.D.)
| | - Sandeep R Das
- Division of Cardiology, Department of Medicine, University of Southwestern Medical Center, Dallas, TX (R.V., S.R.D.)
- Center of Innovation and Value at Parkland, Parkland Health, Dallas, TX (S.R.D.)
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19
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Panattoni G, Monzo L, Gugliotta M, Proietti G, Tatangelo M, Jacomelli I, Zimbardo G, Meringolo F, Fedele E, Calò L. Optimal management of patients after acute coronary syndrome. Eur Heart J Suppl 2023; 25:C84-C89. [PMID: 37125273 PMCID: PMC10132559 DOI: 10.1093/eurheartjsupp/suad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Patients with clinically established atherosclerotic cardiovascular disease are at a very high risk of recurrent cardiovascular events. An adequate management of risk factors and the implementation of healthy behaviours significantly decrease the risk of unfavourable clinical outcomes and future cardiovascular events, including death. Patients discharged after an acute coronary syndrome should be managed according to their individual risk level in order to ensure the appropriate treatment. Nevertheless, care pathways should also take into consideration the available resources and the logistical/structural aspects. In this setting, cardiac rehabilitation is prosed as a multidisciplinary approach to improving daily function and reducing cardiovascular risk factors. The organization of a network with the involvement of different medical and non-medical figures is essential to ensure successful outcomes and expected cost-effectiveness.
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Affiliation(s)
| | - Luca Monzo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
- Centre d' Investigations Cliniques Plurithématique, Université de Lorraine INSERM, 5 Rue du Morvan, 54500 Vandœuvre-lès-Nancy, Francia
| | - Maria Gugliotta
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Giulia Proietti
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Mario Tatangelo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Ilaria Jacomelli
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Giuseppe Zimbardo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Federica Meringolo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
- Department of Biomedical Sciences, Faculty of Medicine, Catholic University “Our Lady of Good Counsel”, Rr. Dritan Hoxha 1000, Tirana, Albania
| | - Elisa Fedele
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
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20
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Krzowski B, Boszko M, Peller M, Hoffman P, Żurawska N, Skoczylas K, Osak G, Kołtowski Ł, Grabowski M, Opolski G, Balsam P. Mobile App and Digital System for Patients after Myocardial Infarction (afterAMI): Results from a Randomized Trial. J Clin Med 2023; 12:jcm12082886. [PMID: 37109223 PMCID: PMC10145296 DOI: 10.3390/jcm12082886] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/08/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Cardiac rehabilitation after acute myocardial infarction is crucial and improves patients' prognosis. It aims to optimize cardiovascular risk factors' control. Providing additional support via mobile applications has been previously suggested. However, data from prospective, randomized trials evaluating digital solutions are scarce. In this study, we aimed to evaluate a mobile application-afterAMI-in the clinical setting and to investigate the impact of a digitally-supported model of care in comparison with standard rehabilitation. A total of 100 patients after myocardial infarction were enrolled. Patients were randomized into groups with either a rehabilitation program and access to afterAMI or standard rehabilitation alone. The primary endpoint was rehospitalizations and/or urgent outpatient visits after 6 months. Cardiovascular risk factors' control was also analyzed. Median age was 61 years; 65% of the participants were male. This study failed to limit the number of primary endpoint events (8% with app vs. 27% without app; p = 0.064). However, patients in the interventional group had lower NT-proBNP levels (p = 0.0231) and better knowledge regarding cardiovascular disease risk factors (p = 0.0009), despite no differences at baseline. This study showcases how a telemedical tool can be used in the clinical setting.
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Affiliation(s)
- Bartosz Krzowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warszawa, Poland
| | - Maria Boszko
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warszawa, Poland
| | - Michał Peller
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warszawa, Poland
| | - Paulina Hoffman
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warszawa, Poland
| | - Natalia Żurawska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warszawa, Poland
| | - Kamila Skoczylas
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warszawa, Poland
| | - Gabriela Osak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warszawa, Poland
| | - Łukasz Kołtowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warszawa, Poland
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warszawa, Poland
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warszawa, Poland
| | - Paweł Balsam
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warszawa, Poland
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21
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Saito Y, Oyama K, Tsujita K, Yasuda S, Kobayashi Y. Treatment strategies of acute myocardial infarction: updates on revascularization, pharmacological therapy, and beyond. J Cardiol 2023; 81:168-178. [PMID: 35882613 DOI: 10.1016/j.jjcc.2022.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/06/2022] [Indexed: 10/16/2022]
Abstract
Owing to recent advances in early reperfusion strategies, pharmacological therapy, standardized care, and the identification of vulnerable patient subsets, the prognosis of acute myocardial infarction has improved. However, there is still considerable room for improvement. This review article summarizes the latest evidence concerning clinical diagnosis and treatment of acute myocardial infarction.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Kazuma Oyama
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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22
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Li Z, Long Y, Yang Q, Liu J, Wang Y. Smartphone-based interventions in the secondary prevention of cardiovascular disease: A meta-analysis. Technol Health Care 2023; 31:1935-1948. [PMID: 37125588 DOI: 10.3233/thc-230022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND A variety of reviews have indicated the effectiveness of smartphone-based interventions in preventing secondary cardiovascular disease (CVD). However, few studies have focused on clinical outcomes. OBJECTIVE This meta-analysis aimed to evaluate the potential benefits of application interventions and short message service (SMS) interventions on CVD outcomes. METHODS Electronic databases were searched to identify randomized controlled trials (RCT) investigating an application or SMS intervention for secondary CVD prevention. Primary outcomes included major adverse cardiovascular events (MACE), cardiovascular death, and cardiac hospitalization. Secondary outcomes were cardiovascular risk factors (BMI, blood pressure, and cholesterol). RESULTS A total of 26 RCTs were included, with 16 investigating applications and 10 assessing SMS. Overall, there was no significant difference in MACE, cardiovascular death, and cardiac hospitalization when comparing application interventions with usual care, as well as comparing SMS with usual care. Subgroup analysis revealed that patients who received applications without a medical interface had a significantly lower incidence of MACE (OR = 0.56; 95% CI: 0.33, 0.98). Participants who received applications with a medical interface showed a tendency towards higher rates of cardiac hospitalization (OR = 2.03; 95% CI: 0.85, 4.87). Significant reduction in waist circumference (SMD =-0.80; 95% CI: -1.58, -0.03) was found in application interventions compared to usual care; while significant reductions in SBP (SMD =-0.08; 95% CI: -0.15, -0.01) and TC (SMD =-0.31; 95% CI: -0.57, -0.08) were found in SMS interventions compared to usual care. CONCLUSION Smartphone-based interventions, including applications and SMS, have the potential to benefit the secondary prevention of CVD. Applications may reduce the incidence of cardiovascular-related adverse events, while SMS interventions may improve cardiovascular risk factors.
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Affiliation(s)
- Zishuo Li
- Department of Administrative Office, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Yanli Long
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Qing Yang
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Jing Liu
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Yahong Wang
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
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23
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Raeside R, Singleton AC, Todd A, Partridge SR, Hyun KK, Kulas H, Wootton SL, Dale MT, Alison JA, McKeough Z, McNamara RJ, Spencer L, Jenkins C, Redfern J. Lung Support Service: Implementation of a Nationwide Text Message Support Program for People with Chronic Respiratory Disease during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17073. [PMID: 36554954 PMCID: PMC9779082 DOI: 10.3390/ijerph192417073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND COVID-19 pandemic lockdowns led to the closure of most in-person pulmonary rehabilitation programs in Australia. Text message programs are effective for delivering health support to aid the self-management of people with chronic diseases. This study aimed to evaluate the implementation of a six-month pre-post text message support program (Texting for Wellness: Lung Support Service), and the enablers and barriers to its adoption and implementation. METHODS This mixed-methods pre-post study used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the Texting for Wellness: Lung Support Service, which is an automated six-month text message support program that included evidence-based lifestyle, disease-self management and COVID-19-related information. Reach was measured by the proportion of participant enrolments and demographic characteristics. Adoption enablers and barriers were measured using text message response data and a user feedback survey (five-point Likert scale questions and free-text responses). Implementation was evaluated to determine fidelity including text message delivery data, opt-outs, and intervention costs to promote and deliver the program. RESULTS In total, 707/1940 (36.4%) participants enrolled and provided e-consent, with a mean age (±standard deviation) of 67.9 (±9.2) years old (range: 23-87 years). Of participants who provided feedback, (326/707) most 'agreed' or 'strongly agreed' that the text messages were easy to understand (98.5%), helpful them to feel supported (92.3%) and helped them to manage their health (88.0%). Factors influencing engagement included a feeling of support and reducing loneliness, and its usefulness for health self-management. Messages were delivered as planned (93.7% successfully delivered) with minimal participant dropouts (92.2% retention rate) and low cost ($AUD24.48/participant for six months). A total of 2263 text message replies were received from 496 unique participants. There were no reported adverse events. CONCLUSION Texting for Wellness: Lung Support Service was implemented quickly, had a broad reach, with high retention and acceptability among participants. The program was low cost and required minimal staff oversight, which may facilitate future implementation. Further research is needed to evaluate the efficacy of text messaging for the improvement of lung health outcomes and strategies for long-term pulmonary rehabilitation program maintenance.
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Affiliation(s)
- Rebecca Raeside
- Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
| | - Anna C. Singleton
- Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
| | - Allyson Todd
- Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
| | - Stephanie R. Partridge
- Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
| | - Karice K. Hyun
- Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW 2137, Australia
| | - Helen Kulas
- NSW Agency for Clinical Innovation, Sydney, NSW 2065, Australia
| | - Sally L. Wootton
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, NSW 2103, Australia
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Marita T. Dale
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Jennifer A. Alison
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Allied Health Research and Education Unit, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Zoe McKeough
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Renae J. McNamara
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Department of Physiotherapy, Prince of Wales Hospital, Sydney, NSW 2031, Australia
- Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Lissa Spencer
- Department of Physiotherapy, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Christine Jenkins
- Institute of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Julie Redfern
- Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia
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24
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Sharma A, Avram R. Opportunities and Challenges of Mobile Health Tools to Promote Health Behaviors. Circulation 2022; 145:1456-1459. [PMID: 35533217 DOI: 10.1161/circulationaha.122.059715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Abhinav Sharma
- DREAM-CV Lab, McGill University Health Centre, Montreal, QC, Canada (A.S.).,Division of Cardiology, Department of Medicine, McGill University, Montreal, QC, Canada (A.S.)
| | - Robert Avram
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, QC, Canada (R.A.)
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