Key Points:
- Cardiac rehabilitation (CR) is a guideline-directed multifaceted intervention that is shown to improve cardiovascular morbidity and mortality, but enrollment is low, especially among underrepresented groups, owing due to multiple patient-level and health-system-level factors
- The mTECH-Rehab trial tested implementation of an equity-focused digital health intervention to determine improvement in functional capacity among study participants
- This study evaluated the functional capacity of participants after 12 weeks using the 6-minute walk test (6MWT) as well as various secondary outcomes important in cardiovascular disease (CVD) prevention
- Though the study’s methodology has been presented previously, preliminary results are forthcoming as the study is ongoing
Cardiac rehabilitation (CR) is an important multipronged intervention that includes supervised exercise, tobacco cessation counseling, nutrition education, management of cholesterol, weight, blood pressure (BP) and diabetes, as well as psychological health promotion. A preponderance of evidence demonstrate that CR improves cardiovascular outcomes, including morbidity and mortality, among patients with cardiovascular disease (CVD) who experience major adverse cardiovascular events (MACEs) or undergo cardiovascular interventions. In addition, similar evidence supports CR as secondary prevention for patients who experience MACEs.
Despite the evidence of its benefits, CR participation is very low: only about 1 in 5 patients with indication for CR attend. Furthermore, disparities are present in CR enrollment, with individuals from underrepresented racial and ethnic groups significantly less likely to participate than their White counterparts. Multiple factors contribute to low CR participation at the level of the patient and health system. For example, low socioeconomic status (SES), advanced age, lack of social support, medical comorbidities, and poor health literacy are all patient-level factors contributing to low CR participation. At the health system level, lack of referrals from clinicians, lack of facilitated enrollment after referral, and lack of outpatient CR availability contribute to low CR participation. Further exacerbating these issues was the COVID-19 pandemic, which led to 143 CR facilities closing between 2019 and 2021 with an overall reduction in CR participation.
The rapid increase in smartphone ownership both domestically and abroad presents an opportunity for CR programs to expand to patients previously unable to participate. Previous evidence suggests that virtual and hybrid CR delivery may be non-inferior to in-person CR for functional status improvement and may promote health equity by eliminating geographic and logistical barriers (e.g. transportation access, parking problems, limited hours of operation, etc.). In this study, the investigators employ an equity-focused, mobile health technology enabled digital health intervention designed by a multidisciplinary team, creating a hybrid CR program combining traditional, center-based CR with home-based CR technology. The study investigators hypothesized that this hybrid program would be non-inferior to traditional CR in improving functional status and cardiovascular health.
The study evaluated the functional capacity of participants using the 6-minute walk test (6MWT) 12 weeks after randomization. Secondary outcomes also included change in secondary CVD prevention metrics (LDL cholesterol, A1c, blood pressure, weight, physical activity, smoking, and diet), difference in engagement in CR, and change in quality of life. 202 patients were randomized to either usual care with a 12-week center-based CR program or a technology-enabled, data-driven 12-week coaching and home exercise program with the option to attend in-person CR sessions.
Although the study investigators have previously published their methodology in JAHA, the preliminary results are forthcoming as the study is ongoing. Ultimately, the mTECH-Rehab trial is determining whether a new, health-equity focused mobile health technology enabling hybrid CR is an effective alternative to in-person CR for improving functional status and preventing CVD.
- Isakadze N, Kim CH, Marvel FA, Ding J, MacFarlane Z, Gao Y, Spaulding EM, Stewart KJ, Nimbalkar M, Bush A, Broderick A, Gallagher J, Molello N, Commodore-Mensah Y, Michos ED, Dunn P, Hanley DF, McBee N, Martin SS, Mathews L. Rationale and Design of the mTECH-Rehab Randomized Controlled Trial: Impact of a Mobile Technology Enabled Corrie Cardiac Rehabilitation Program on Functional Status and Cardiovascular Health. J Am Heart Assoc. 2024 Jan 16;13(2):e030654. doi: 10.1161/JAHA.123.030654. Epub 2024 Jan 16. PMID: 38226511; PMCID: PMC10926786.