JMIR Publications

ABSTRACT

Background:

Background:

People with coronary heart disease are at increased risk of morbidity and mortality, even if they attend cardiac rehabilitation. Sedentary behavior remains high in this group and potentially contributes to this morbidity. Behavioral smartphone applications may be feasible to facilitate sedentary behavior reductions and lead to reduced healthcare utilization.

Objective:

Objective:

To test the effect of a sedentary behavior change smartphone application (Vire app and online ToDo-CR program) as an adjunct to cardiac rehabilitation on hospital admissions and emergency department (ED) presentations over 12-months.

Methods:

Methods:

A multi-center, randomised controlled trial was conducted with 120 participants recruited from cardiac rehabilitation participants. Participants were randomised 1:1 to cardiac rehabilitation plus the fully automated 6-month Vire app and online ToDo-CR program (intervention) or usual care cardiac rehabilitation (control). The primary outcome was non-elective hospital admissions and ED presentations over 12-months. Secondary outcomes including accelerometer-measured sedentary behavior, body mass index, waist circumference and quality of life were recorded at baseline, 6- and 12-months. Logistic regression models were used to analyze the primary outcome and linear mixed-effects models for secondary outcomes. Intervention and hospital admission costs were collected, and the incremental cost-effectiveness ratios (ICER) were calculated for secondary outcomes.

Results:

Results:

Participants were aged 62±10years and majority male (77.5%). Intervention group participants were more likely to experience all-cause (OR 1.54, 95%CI 0.58 to 4.10, p=0.39) and cardiac-related (OR 3.26, 95%CI 0.84 to 12.55, p=0.09) hospital admissions and ED presentations (OR 2.07, 95%CI 0.89 to 4.77, p=0.09) compared to the control group. Despite this, cardiac-related hospital admission costs were lower in the intervention group over 12-months ($252.40 vs $859.38, p=0.24). There were no significant between-group differences in sedentary behavior minutes-per-day over 12-months, though the intervention group completed 22-minutes less than the control, with a small effect size (95%CI -22.80 to 66.69, p=0.33, Cohen d=0.21). The intervention group had lower body mass index (β=1.62, p=0.05), waist circumference (β=5.81, p=0.01), waist-to-hip ratio (β=0.03, p=0.03) and lower quality of life (β=3.30, p=0.05) over 12-months compared to the control group. The intervention was more effective but also more costly in achieving a reduction in body mass index (ICER $2,686.52) at 6-months, sedentary behavior (ICER $351.77) at 12-months, anxiety at 6- (ICER $2,808.64) and 12-months (ICER $10,987.71), and an increase in light-intensity physical activity (ICER $643.65) at 6-months, and quality of life at 6- (ICER $61,790.00) and 12-months (ICER $93,395.50).

Conclusions:

Conclusions:

The Vire app and online ToDo-CR program was not an outcome effective or cost-effective solution to reduce all-cause hospital admissions or ED presentations in cardiac rehabilitation participants compared to usual care. Behavioral smartphone apps that target sedentary behavior alone may not be effective solutions in cardiac rehabilitation participants to reduce hospital admissions and sedentary behavior. Clinical Trial: Australian New Zealand Clinical Trials Registry (ACTRN12619001223123)