JMIR Publications

ABSTRACT

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. Digital health technologies 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, a systematic evaluation of the current literature on digital interventions for CR is lacking.

Objective:

The objective of this systematic literature review is to provide an in-depth analysis of the potential for digital health technologies to address the challenges associated with traditional CR. Through this review, we 1) summarize the current literature on digital interventions for CR, 2) identify the key components of CR that have been successfully addressed through digital interventions, and 3) describe gaps in research that need to be addressed for sustainable and scalable digital CR interventions.

Methods:

Our search strategy for identifying primary literature pertaining to CR with digital solutions consisted of querying MEDLINE, Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018 and consulting with an expert in the field of digital CR.

Results:

Our search returned 34 eligible studies, of which 22 were randomized trials. The digital CR interventions reviewed primarily targeted physical activity counseling (94%; n = 32) and exercise training (85%; n = 29). The most common modalities were smartphone/mobile devices (59%; n=20), online portals (56%; n=19), and pedometer devices (29%; n=10). The CR core components of patient assessment and nutrition counseling were aspects of 28 (82%) and 12 (35%) digital CR interventions, respectively. In contrast, less than a third of the studies addressed other CR core components including management of lipids, diabetes, smoking cessation, blood pressure, weight, and psychological health. Of the studies reviewed, 23 of the digital interventions were intended to serve as stand-alone CR programs.

Conclusions:

Digital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, interventions that have previously been evaluated are primarily focused on physical activity counseling and exercise training without the other core components of CR. Thus, further research is required with more comprehensive CR interventions and long-term follow-up in order to understand the clinical impact of digital interventions.