Table 2.
Digital health trials in ASCVD and cardiac rehabilitation
| First author | Country | Age mean (SD) | N | Race ethnicity | Duration | Inclusion criteria | Primary outcome | Results | Device | Intervention |
|---|---|---|---|---|---|---|---|---|---|---|
| Brath et al. (2013) [60] | Austria | 69 (4.8) | 53 | Not reported | 40 weeks | At least 2 diagnoses: HTN, DM2, HLD | Intake rate at 20 weeks | Significant difference in Metformin adherence. No difference in the other 3 medications | Electronic blister + NFC capable smartphone | Adherence text reminders to participants and adherence information to physicians |
| Petrella et al. (2014) [61] | Canada | 56.7 (9.4) | 149 | 100% Caucasian | 12 weeks | At least 2 risk factors* | SBP at 12 weeks. Secondary outcome: waist circumference, HBA1c, HDL, LDL | SBP mean change greater in IT vs control. No difference in secondary outcomes | Smartphone, app, glucometer, HBPM, weight scale, pedometer | Individualized exercise program + home monitoring kit |
| Chow et al. (2016) [62] | Australia | 58 (9.2) | 710 | 66.6% European, 10.7% South Asian, 10.1% other Asian, 9.9% Arab | 6 months | ≥ 18 years of age and documented CHD** | LDL-C level at 6 months | Significant difference in LDL-C of − 5 mg/dL (− 9 to 0, P = 0.4) | Text messages | Semi-personalized text messages with motivation to improve diet, exercise, and smoking cessation |
| Anand et al. (2016) [63] | Canada | 50.6 (11.4) | 343 |
100% South Asian (90% India, 2.3% Pakistan, 5.2% Sri Lanka) |
1 year | South Asian ≥ 30 years of age | MI scores at 12 months | Relative change between IT and control was not significant (− 0.27, − 1.12 to 0.58, P = 0.53) | Email messages | Change-oriented motivational, diet, and physical activity messages |
| Salisbury et al. (2016) [64] | UK | 67.4 (4.8) | 641 | 99% White | 1 year | 40–74 years of age + QRISK2 10-year risk score of ≥ 20% and modifiable diseases*** | Maintaining or decreasing QRISK2 score at 12 months |
Proportion that maintained or improved was not significantly different in IT vs control 50 vs 42% (OR 1.3, 1.0–1.9, P = 0.08) |
Telephone calls + web portal | Health advisor plus computerized behavioral management program |
| Skobel et al. (2017) [65] | UK, Germany, Spain | 59 (14) | 132 | Not reported | 6 months | Hx of acute MI or CAD s/p PCI, LVEF ≥ 30% | Peak VO2 max at 6 months in HBCR$ vs CBCR# national standards | Peak VO2 max change 1.76 ± 4.1 ml/min/kg in HBCR vs − 0.4 ± 2.7 ml/min/kg in CBCR, P = 0.005 |
•Smartphone •ECG •Vest •Vital sign senor •Physician-facing platform |
Asynchronous home-based cardiac rehabilitation |
| Hwang et al. (2017) [66] | Australia | 67 | 53 | 92% Caucasian | 12 weeks | ≥ 18 years of age and recent heart failure admission, diagnosis confirmed by echocardiogram | Non-inferiority: change in 6-min walk distance HBCR vs CBCR | At 12 weeks, there was no between-group difference 15 m (95% CI − 28 to 59); F = 1.39, P = 0.24 |
•Laptop •Mobile broadband •HBPM •Pulse oximeter •Weight and resistance bands |
Synchronous videoconference home-based cardiac rehabilitation |
| Harzand et al. (2018) [67] | US | 65 (5) | 18 | 50% African American | 12 weeks | ≥ 18 years with coronary heart disease plus on indication for cardiac rehabilitation | BP and functional capacity (single arm feasibility study) | Improvement in metabolic equivalent from 5.3 to 6.3, P = 0.008; mean BP at rest decreased from 1401 to 130.5, P = 0.039 |
•Smartphone platform •Hospital-facing dashboard |
Asynchronous home-based cardiac rehabilitation |
| Peng et al. (2018) [68] | China | 66.3 (10.5) | 98 | Not reported | 4 months | ≥ 18 years, heart failure for at least 3 month and NYHA class I–III | Primary: QoL, secondary: 6-min walking distance, LVEF and heart rate | Statistically significant changes in QoL scores, 6-min walk distance and heart rate | Web-based platform | Synchronous videoconference home-based cardiac rehabilitation |
| Maddison et al. (2019) [69] | New Zealand | 61 (13) | 162 | 75.3% NZ European, 4.3% NZ Maori, 2.5% Pacific, 8% Asian | 12 weeks | ≥ 18 years with coronary heart disease within 6 months | Non-inferiority outcomes: VO2 max at 12 weeks | Adjusted mean VO2 max difference = 0.46, 95% CI − 0.92 to 1.84 ml/kg/min, P = 0.51 |
•Smartphone •Chest-word wearable sensor •Apps and Web Platform |
Synchronous home-based cardiac rehabilitation |
| Tekkesin et al. (2021) [70] | Turkey | Mean:59 (53–64) | 283 | Not reported | 1 year | 20–79 years of age with 10 years ASCVD score ≥ 7.5% | ASCVD scores at one year | IT vs UC reduced ASCVD score by difference of − 2.7% (− 2.2 to − 3.3, P ≤ 0.0001) | Smartphone, weight scale, smart wrists band and HBPM | Daily upload of data with motivational messages and feedback |
| Bae et al. (2021) [71] | Korea | 60.4 (10.5) | 879 | Not reported | 6 months | CHD and underwent PCI | LDL-C, SBP and BMI change at 6 months | No significant difference in any outcome: LDL-C, SBP, and BMI | Text messages | Semi-personalized text messages with motivation to improve diet, exercise, and smoking cessation |
*Waist circumference ≥ 88 cm (women) or 102 cm (men); SBP ≥ 135 mmHg and/or DBP ≥ 85 mmHg; fasting plasma glucose ≥ 6.1 mmol/l; fasting triglycerides ≥ 1.7 mmol/l; fasting HDL ≤ 1.29 mmol/l (women) or 1.02 mmol/l (men)
**Defined as documented prior myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention, or 50% or greater stenosis in at least 1 major epicardial vessel on coronary angiography
***Systolic blood pressure ≥ 140 mm Hg, body mass index ≥ 30, being a current smoker, or any combination of these
$Home-based cardiac rehabilitation
#Center-based cardiac rehabilitation