Digital health interventions for cardiac rehabilitation: Systematic literature review

Shannon Wongvibulsin, Evagelia E. Habeos, Pauline P. Huynh, Helen Xun, Rongzi Shan, Kori A. Porosnicu Rodriguez, Jane Wang, Yousuf K. Gandapur, Ngozi Osuji, Lochan M. Shah, Erin M. Spaulding, George Hung, Kellen Knowles, William E. Yang, Francoise A. Marvel, Eleanor Levin, David J. Maron, Neil F. Gordon, Seth S. Martin

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR. Objective: The objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions. Methods: Our strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018. Results: Our search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure. Conclusions: Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions.

Original languageEnglish (US)
Article numbere18773
JournalJournal of medical Internet research
Volume23
Issue number2
DOIs
StatePublished - Feb 2021
Externally publishedYes

Keywords

  • Cardiac rehabilitation
  • Digital technologies
  • MHealth
  • Mobile phone
  • Telemedicine

ASJC Scopus subject areas

  • Health Informatics

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