Effect of a Lifestyle-Focused Web-Based Application on Risk Factor Management in Patients Who Have Had a Myocardial Infarction: Randomized Controlled Trial

• Published in: Journal of medical Internet research Vol. 24; no. 3; p. e25224
• Main Authors: Ögmundsdóttir Michelsen, Halldóra, Sjölin, Ingela, Bäck, Maria, Gonzalez Garcia, Manuel, Olsson, Anneli, Sandberg, Camilla, Schiopu, Alexandru, Leósdóttir, Margrét
• Format: Journal Article
• Language: English
• Published: Canada Journal of Medical Internet Research 31.03.2022; Gunther Eysenbach MD MPH, Associate Professor; JMIR Publications
• Subjects: Adherence; Application; Blood pressure; Cardiac patients; cardiac rehabilitation; Cardiology and Cardiovascular Disease; cardiovascular; Cardiovascular disease; Cardiovascular diseases; Change agents; Clinical Medicine; Clinical trials; Diet; eHealth; Evidence-based medicine; Exercise; Fish; Habits; Heart attack; Heart attacks; Humans; Internet; Intervention; Kardiologi och kardiovaskulära sjukdomar; Klinisk medicin; Life Style; Lifestyles; Medical and Health Sciences; Medicin och hälsovetenskap; mobile device app; mobile phone; Morbidity; Mortality; Myocardial infarction; Myocardial Infarction - therapy; Original Paper; Physical activity; Physical fitness; Quality of Life; Rehabilitation; Risk Factors; Self control; Smoking cessation; Software; Uptake; web-based application; Sweden; mobile device app; risk factors; mobile phone; cardiovascular; web-based application; cardiac rehabilitation; eHealth
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/25224

Cardiac rehabilitation is central in reducing mortality and morbidity after myocardial infarction. However, the fulfillment of guideline-recommended cardiac rehabilitation targets is unsatisfactory. eHealth offers new possibilities to improve clinical care. This study aims to assess the effect of a web-based application designed to support adherence to lifestyle advice and self-control of risk factors (intervention) in addition to center-based cardiac rehabilitation, compared with cardiac rehabilitation only (usual care). All 150 patients participated in cardiac rehabilitation. Patients randomized to the intervention group (n=101) received access to the application for 25 weeks where information about lifestyle (eg, diet and physical activity), risk factors (eg, weight and blood pressure [BP]), and symptoms could be registered. The software provided feedback and lifestyle advice. The primary outcome was a change in submaximal exercise capacity (Watts [W]) between follow-up visits. Secondary outcomes included changes in modifiable risk factors between baseline and follow-up visits and uptake and adherence to the application. Regression analysis was used, adjusting for relevant baseline variables. There was a nonsignificant trend toward a larger change in exercise capacity in the intervention group (n=66) compared with the usual care group (n=40; +14.4, SD 19.0 W, vs +10.3, SD 16.1 W; P=.22). Patients in the intervention group achieved significantly larger BP reduction compared with usual care patients at 2 weeks (systolic -27.7 vs -16.4 mm Hg; P=.006) and at 6 to 10 weeks (systolic -25.3 vs -16.4 mm Hg; P=.02, and diastolic -13.4 vs -9.1 mm Hg; P=.05). A healthy diet index score improved significantly more between baseline and the 2-week follow-up in the intervention group (+2.3 vs +1.4 points; P=.05), mostly owing to an increase in the consumption of fish and fruit. At 6 to 10 weeks, 64% (14/22) versus 46% (5/11) of smokers in the intervention versus usual care groups had quit smoking, and at 12 to 14 months, the respective percentages were 55% (12/22) versus 36% (4/11). However, the number of smokers in the study was low (33/149, 21.9%), and the differences were nonsignificant. Attendance in cardiac rehabilitation was high, with 96% (96/100) of patients in the intervention group and 98% (48/49) of patients receiving usual care only attending 12- to 14-month follow-up. Uptake (logging data in the application at least once) was 86.1% (87/101). Adherence (logging data at least twice weekly) was 91% (79/87) in week 1 and 56% (49/87) in week 25. Complementing cardiac rehabilitation with a web-based application improved BP and dietary habits during the first months after myocardial infarction. A nonsignificant tendency toward better exercise capacity and higher smoking cessation rates was observed. Although the study group was small, these positive trends support further development of eHealth in cardiac rehabilitation. ClinicalTrials.gov NCT03260582; https://clinicaltrials.gov/ct2/show/NCT03260582. RR2-10.1186/s13063-018-3118-1.