Cardiac rehab uptake improves with mobility

A clinical trial of a cardiac rehabilitation program using mobile phone technology has shown a large increase in uptake and completion rates.

The trial, a joint initiative between the Australian eHealth Research Centre (AeHRC), the Prince Charles Hospital and Metro North Primary and Community Health Services in Brisbane, has been ongoing since 2006, with clinical results due to be published later this year.

David Hansen, CEO of the AeHRC, told today's CeBIT conference in Sydney that a randomised controlled study had shown 80 per cent of patients in the mobile phone trial had participated in cardiac rehab and completed the program successfully.

This compares with 47 per cent completion rates using traditional cardiac rehab programs, which often require patients to attend hospital regularly.

“Cardiac rehabilitation is the single most effective tool to reducing [readmission] of patients to hospitals with another cardiac event, so getting someone to complete one of these trials is really effective,” Dr Hansen said. “It greatly reduces hospital admissions for another cardiac event in the next five years. But there is a lack of referrals – not many people are referred to these programs, and then there is a lack of uptake and completion.”

Dr Hansen said some studies had shown that between 16 and 19 per cent of eligible patients complete cardiac rehab programs, despite good evidence that patients who do complete them are much less likely to end up back in hospital in the next five years.

The project, called the Care Assessment Platform, began in 2006 with patients recruited in 2008. Mobile phone manufacturer Nokia donated 80 of its smartphones to the program, and the team developed a number of resources including a wellness diary application on the phone, into which patients put daily updates, along with multimedia information such as videos from the Australian Heart Foundation.

Participants were also assigned a mentor who spoke to the patient once a week and could monitor their results through a web portal, to which the patient also had access.

“During the trial we introduced additional connectivity to other devices – we used a step counter to measure walking activity, we connected to blood pressure units,” Dr Hansen said. “And then there is a portal that goes with this which either the patient or the carer can visualise and show them how they are going with their blood pressure and exercise etc.”

One of the best results from the trial was that patients generally stuck with it and updated their wellness diary daily.

“The first man to come into the trial was a 71-year-old who had had a heart attack and had never used a mobile phone in his life,” he said. “After six months we had trouble getting the phone back. He really liked that he was putting in data, collecting it, he was able to self-manage and he had a mentor to talk to once a week."

The randomised control trial recruited 120 patients, 60 of whom used the mobile application and 60 who undertook a traditional program. Dr Hansen admitted that one of the big hurdles was to get enough people to agree to the traditional program. “Most people were only interested in the mobile phone-based one.”

The results showed that of the mobile phone group, 80 per cent adhered to and completed the program, compared to 47 per cent in the traditional program. “We are extremely happy with that,” he said. “If that was replicated across the population who have had heart attacks, we'd be talking about $1 billion improvement in productivity to the Australian economy.”

He said more data would be available later this year on clinical indicators such as lipid levels, and the team was now developing a more agnostic mobile web implementation which will work across all smartphones, particularly iPhones.

“The other [positive outcome] was ease of use,” he said. “This is really positive when it comes to the PCEHR, which is going to enable many more of these programs. People were generally putting in data every day.”

Posted in Australian eHealth

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