Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: May 17, 2022
Date Accepted: Oct 11, 2022
Effectiveness of mobile health interventions in the control of lifestyle and cardiovascular risk factors in patients after a coronary event: A systematic review and meta-analysis
ABSTRACT
Background:
Coronary artery disease is the main cause of death and loss of disability-adjusted life years around the world. Information and communication technology has become an important part of healthcare systems, including the innovative Cardiac Rehabilitation service through mobile phone and m-Health interventions.
Objective:
This study aims to determine the effectiveness of the different kinds of m-Health programs in changing lifestyle behavior, adherence to treatment, the control of modifiable cardiovascular risk factors, and psychosocial outcomes in patients that have experienced a coronary event.
Methods:
A systematic review of the literature was performed following PRISMA guidelines. A thorough search of the following biomedical databases was conducted: PubMed, Embase, Web of Science, Scielo, CINAHL, Scopus, The clinical Trial, and Cochrane. Articles were included that were randomized clinical trials that involved an intervention consisting of an m-health program using a mobile application in patients after a coronary event. The articles analyzed some of the following as outcome variables: changes in lifestyle behavior, cardiovascular risk factors, and anthropometric and/or psychosocial variables. A meta-analysis of the variables studied was performed with the Cochrane tool. The risk of bias was assessed using the Cochrane Collaboration tool for measuring the risk of bias, the quality of the evidence using the GRADE tool, and heterogeneity was measured using the I2 test.
Results:
A total of 23 articles were included in the review and 20 in the meta-analysis, with a total sample size of 4,535 patients. Exercise capacity using the 6-minute walk test (MD = 21.64, 95% CI 12.72 to 30.55, P <.00001), physical activity (SMD = 0.42, 95% CI 0.04 to 0.81, P =.03) and adherence to treatment (RD = 0.19, 95% CI 0.11 to 0.28, P <.00001) were significantly superior in the m-Health group. Furthermore, both the physical and mental dimensions of quality of life were better in the m-Health group (SMD = 0.26, 95% CI 0.09 to 0.44, P =.004), (SMD = 0.27, 95% CI 0.06 to 0.47, P =.01). In addition, hospital readmissions for both all causes and cardiovascular causes were statistically higher in the control group than in the m-Health group (SMD = -0.03, 95% CI -0.05 to -0.00, P =.04), (SMD = -0.04, 95% CI -0.07 to -0.00, P =.05).
Conclusions:
Mobile health technology has a positive effect on patients that have experienced a coronary event in terms of their exercise capacity, physical activity, adherence to medication, and physical and mental quality of life, and also regarding readmissions for all causes and cardiovascular causes.
Citation
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Copyright
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