Patient interest in mHealth as part of cardiac rehabilitation in Switzerland
Smartphone-based health interventions (mHealth) offer the potential to overcome barriers to accessibility of cardiac rehabilitation. We aimed (1) to examine patients’ interest in mHealth as part of the outpatient cardiac rehabilitation (phase II) and long-term aftercare (phase III) and (2) to identify the influence of sociodemographic and clinical patient characteristics on interest in mHealth.
A questionnaire was consecutively handed out to 2041 patients concluding outpatient cardiac rehabilitation between March 2013 and December 2018 at the University Hospital Bern. Multivariate logistic models were used to identify influencing factors (age, sex, smartphone ownership, year, compliance with cardiac rehabilitation, physical fitness, body mass index, diabetes mellitus, German speaking) for mHealth interest.
The questionnaire was returned by 1025 patients (50.2% response rate). Seventy-one percent of the responding patients preferred the cardiac rehabilitation as offered with three weekly centre-based sessions, whereas 12% preferred and 17% considered replacing two out of the three centre-based sessions per week with mHealth. Forty-eight percent were interested in continuing exercise training using mHealth after completion of cardiac rehabilitation. Smartphone ownership was the most important indicator for patient interest in mHealth (odds ratio [OR] 2.54, 95% confidence interval [CI] 1.53–4.23), whereas age (per year) was not independently associated with mHealth interest for phase II (OR 0.99, 95% CI 0.98–1.01) and only weakly associated with phase III (OR 0.98, 95% CI 0.96–0.99).
In a Swiss urban region with easy access to cardiac rehabilitation, patients who participated in a centre-based cardiac rehabilitation programme between 2013 and 2018 showed little interest in mHealth during phase II. However, almost half of them expressed interest in continuing training with mHealth during phase III.
- Piepoli MF Corrà U Adamopoulos S Benzer W Bjarnason-Wehrens B Cupples M Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology. Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for Cardiovascular Prevention & Rehabilitation. Eur J Prev Cardiol. 2014;21(6):664–81. doi:.https://doi.org/10.1177/2047487312449597
- Leon AS Franklin BA Costa F Balady GJ Berra KA Stewart KJ American Heart Association Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) American association of Cardiovascular and Pulmonary Rehabilitation. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2005;111(3):369–76. doi:.https://doi.org/10.1161/01.CIR.0000151788.08740.5C
- Kotseva K Wood D de Backer G de Bacquer D EUROASPIRE III Study Group. Use and effects of cardiac rehabilitation in patients with coronary heart disease: results from the EUROASPIRE III survey. Eur J Prev Cardiol. 2013;20(5):817–26. doi:.https://doi.org/10.1177/2047487312449591
- Neubeck L Freedman SB Clark AM Briffa T Bauman A Redfern J. Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data. Eur J Prev Cardiol. 2012;19(3):494–503. doi:.https://doi.org/10.1177/1741826711409326
- Clark RA Conway A Poulsen V Keech W Tirimacco R Tideman P. Alternative models of cardiac rehabilitation: a systematic review. Eur J Prev Cardiol. 2015;22(1):35–74. doi:.https://doi.org/10.1177/2047487313501093
- Rawstorn JC Gant N Direito A Beckmann C Maddison R. Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis. Heart. 2016;102(15):1183–92. doi:.https://doi.org/10.1136/heartjnl-2015-308966
- Maddison R Rawstorn JC Stewart RAH Benatar J Whittaker R Rolleston A Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial. Heart. 2019;105(2):122–9. doi:.https://doi.org/10.1136/heartjnl-2018-313189
- Xu L Li F Zhou C Li J Hong C Tong Q. The effect of mobile applications for improving adherence in cardiac rehabilitation: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2019;19(1):166. doi:.https://doi.org/10.1186/s12872-019-1149-5
- Saner H van der Velde E. eHealth in cardiovascular medicine: A clinical update. Eur J Prev Cardiol. 2016;23(2, suppl):5–12. doi:.https://doi.org/10.1177/2047487316670256
- Pfaeffli Dale L Whittaker R Dixon R Stewart R Jiang Y Carter K Acceptability of a mobile health exercise-based cardiac rehabilitation intervention: a randomized trial. J Cardiopulm Rehabil Prev. 2015;35(5):312–9. doi:.https://doi.org/10.1097/HCR.0000000000000125
- Buys R Claes J Walsh D Cornelis N Moran K Budts W Cardiac patients show high interest in technology enabled cardiovascular rehabilitation. BMC Med Inform Decis Mak. 2016;16(1):95. doi:.https://doi.org/10.1186/s12911-016-0329-9
- Swiss Federal Statistical Office. STAT_TAB Internetnutzungsmodalitäten und Kompetenzen. https://www.pxweb.bfs.admin.ch/pxweb/de/px-x-1604000000_106/ [Accessed 2020 March 10.
- Or CK Karsh BT. A systematic review of patient acceptance of consumer health information technology. J Am Med Inform Assoc. 2009;16(4):550–60. doi:.https://doi.org/10.1197/jamia.M2888
- Reiners F Sturm J Bouw LJW Wouters EJM. Sociodemographic Factors Influencing the Use of eHealth in People with Chronic Diseases. Int J Environ Res Public Health. 2019;16(4):645. doi:.https://doi.org/10.3390/ijerph16040645
- Gordon NP Hornbrook MC. Older adults’ readiness to engage with eHealth patient education and self-care resources: a cross-sectional survey. BMC Health Serv Res. 2018;18(1):220. doi:.https://doi.org/10.1186/s12913-018-2986-0
- Duplaga M. A cross-sectional study assessing determinants of the attitude to the introduction of eHealth services among patients suffering from chronic conditions. BMC Med Inform Decis Mak. 2015;15(1):33. doi:.https://doi.org/10.1186/s12911-015-0157-3