Accepted for/Published in: JMIR Human Factors
Date Submitted: Feb 5, 2020
Date Accepted: Mar 18, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Usability of and Adherence to a Novel, Home-based Cardiac Telerehabilitation Program for Heart Attack Survivors: The MI-PACE Cohort Study
ABSTRACT
Background:
Cardiac rehabilitation (CR) programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after an acute myocardial infarction (AMI).
Objective:
In this pilot study, we developed and assessed the feasibility of delivering a novel health watch-informed 12-week tele-CR program to AMI survivors who declined participation in center-based CR.
Methods:
We enrolled hospitalized AMI survivors at an academic medical center who were eligible for, but declined, center-based CR. All participants underwent a baseline exercise stress test. Participants received a health watch that monitored heart rate (HR) and activity, and a tablet computer with an application that displayed progress towards accomplishing weekly walking and exercise goals. Results were transmitted to a CR nurse via a secure connection. For 12 weeks, participants exercised at home using HR and walking targets, and also participated in weekly phone counseling sessions with the CR nurse, who provided personalized CR problem solving and standard CR education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life.
Results:
Eighteen participants completed the 12-week telerehabilitation program. Their mean age was 59 (SD 7) years, 33% were women, and 33% had an ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (Q1, Q3: 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants on average walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their targeted exercise heart rate zone. Overall, participants found the system to be highly usable (median System Usability Scale score of 83 (Q1, Q3: 65, 100).
Conclusions:
This pilot study established the feasibility of delivering tele-CR at home to AMI survivors via a health watch-based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Additional studies with larger patient samples are warranted to compare center-based rehabilitation and telerehabilitation on patient outcomes and healthcare resource utilization.
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