TY - JOUR
T1 - Digital health interventions for cardiac rehabilitation
T2 - Systematic literature review
AU - Wongvibulsin, Shannon
AU - Habeos, Evagelia E.
AU - Huynh, Pauline P.
AU - Xun, Helen
AU - Shan, Rongzi
AU - Porosnicu Rodriguez, Kori A.
AU - Wang, Jane
AU - Gandapur, Yousuf K.
AU - Osuji, Ngozi
AU - Shah, Lochan M.
AU - Spaulding, Erin M.
AU - Hung, George
AU - Knowles, Kellen
AU - Yang, William
AU - Marvel, Francoise A.
AU - Levin, Eleanor
AU - Maron, David J.
AU - Gordon, Neil F.
AU - Martin, Seth S.
N1 - Funding Information:
The authors thank Julie Nanavati, MLS, MA, (Johns Hopkins Welch Medical Library Informationist) for her assistance in developing the search strategy and downloading the references. SW is supported by the Johns Hopkins School of Medicine Medical Scientist Training Program (National Institutes of Health: Institutional Predoctoral Training Grant – 5T32GM007309) and the National Institutes of Health: Ruth L. Kirschstein Individual Predoctoral NRSA for MD/PhD: F30 Training Grant (F30HL142131). ES is supported by the National Institutes of Health (NIH)/National Institute of Nursing Research (NINR) F31 NR017328, Ruth L. Kirschstein National Research Service Award and NIH/NINR T32 NR012704, predoctoral fellowship in interdisciplinary cardiovascular health research. KR was supported by grant TL1 TR003100 from the National Center for Advancing Translational Sciences, NIH. Funding sources for this project had no role in the design or conduct of the study or in data collection, management, or analysis, manuscript preparation, or in decisions about submitting the manuscript for publication. SM receives research support from the Aetna Foundation, the American Heart Association (20SFRN35380046 and COVID19-811000), the David and June Trone Family Foundation, the Pollin Digital Innovation Fund, Google, Patient-Centered Outcomes Research Institute (ME-2019C1-15328), the National Institutes of Health (P01 HL108800), Nokia, and the PJ Schafer Memorial Fund.
Publisher Copyright:
© 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.
PY - 2021/2
Y1 - 2021/2
N2 - 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.
AB - 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.
KW - Cardiac rehabilitation
KW - Digital technologies
KW - MHealth
KW - Mobile phone
KW - Telemedicine
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U2 - 10.2196/18773
DO - 10.2196/18773
M3 - Review article
C2 - 33555259
AN - SCOPUS:85101004459
SN - 1439-4456
VL - 23
JO - Journal of Medical Internet Research
JF - Journal of Medical Internet Research
IS - 2
M1 - e18773
ER -