Reference and country | Intervention arm | Control group | Sample size | Population | Mean age (SD) | Men (%) | Outcome measure | Measurement time points | Effects of the intervention | Intervention use |
---|---|---|---|---|---|---|---|---|---|---|
m-health | ||||||||||
Thakkar et al. 2016 [27] Australia. | Text messages in addition to traditional exercise based CR. | Traditional exercise based CR. | 710 (IG:352 CG: 358) | Patients with CAD. | 57.6 (9.18) | 81.9 | PO: Physical activity. | Baseline and after 6 months. | Effects on physical activity. | Seven patients requested the text messages to be stopped during follow-up. |
Chow et al. 2016 [28] Australia. | Text messages in addition to traditional exercise based CR. | Traditional exercise based CR. | 710 (IG:352 CG: 358) | Patients with CAD. | 57.6 (9.18) | 81.9 | PO: LDL-cholesterol level at 6 months. SO: Systolic blood pressure, heart rate, total cholesterol level, BMI, waist circumference, total physical activity, smoking status, proportion achieving guideline levels of modifiable risk factors, and adherence to medications. | Baseline and after 6 months. | Effects on LDL-cholesterol level, systolic blood pressure, BMI and smoking | Seven patients requested the text messages to be stopped during follow-up. |
Johnston et al. 2016 [30] Sweden. | An interactive web-based smartphone application and standard secondary prevention care | A simplified Web-based smartphone application and standard secondary prevention care. | 174 (IG:91 CG: 83) | Ticagrelor-treated MI patients. | 58 (8) | 81 | PO: Adherence to Ticagrelor, BMI, physical activity, smoking cessation, quality of life. SO: Patient medication use. Quality of life. Tools impact on CV risk factors, use of the tool over time, system usability and satisfaction, safety of the tool. | Evaluated at visit 2, 3 and after 6 months. | Effect on self-reported medication adherence in e-diary. | The proportion of patients who prematurely stopped using the e-diary was low and did not differed between the 2 study groups. |
Fang et al. 2016 [32] China. | A: Personalized text messages. B: Personalized text messages and a smartphone application. | Telephone call. | 280 (IGa:95;IGb:92 CG: 93) | Patients with chronic stable angina. | 53.6 | 71 | PO: Self-reported medication adherence. | Baseline and after 6 months. | No effect |  |
Park et al. 2015 [37] USA. | A: Text messages for medication reminders and education. B: Text messages for education. | No text messages. | 90 (IGa:30 IGb:30 CG: 30) | Patients hospitalized for ACS. | 52.9 (9.4) | 75 | PO: Patient self-reported medication adherence, self-efficacy. SO: Social support, depression. | Baseline and after 30 days. | Effect in the percentage of prescribed number of dose taken, correct doses taken and doses taken on schedule. |  |
Khonsari et al.2015 [39] Kuala Lumpur. | Text messages medication reminders. | Cardiac rehabilitation and follow-up appointments with cardiologist. | 62 (IG:31 CG: 31) | Patients with ACS. | 57.9 (12.64) | 85.5 | PO: The ratio of adherent patients to complete cardiac medication therapy. SO: Heart functional status (NYHA), ACS-related hospital readmission and death rates. | Baseline and after 8 weeks. | Effect in self-reported medication adherence, heart functional status. | 93.5% said the system was useful and 64.5% felt that it had helped them taking their medications. 80% requested for the SMS reminders to be continued. |
Park et al. 2014 [38] USA. | A: Text messages for medication reminders and education. B: Text messages for education. | No text messages. | 90 (IGa:30 IGb:30 CG: 30) | Patients hospitalized for ACS. | 52.9 (9.4) | 75 | PO: Medication adherence.SO: Feasibility and patient satisfaction. | Baseline and after 30 days. | Effect in the percentage of prescribed number of dose taken, correct doses taken and doses taken on schedule. |  |
Blasco et al. 2012 [44] Spain. | m-health application including telemonitoring and text messages, lifestyle counseling and three clinical visits. | Three clinical visits and lifestyle counseling. | 203 (IG:102 CG: 101) | Patients with ACS. | 61 (11.5) | 83 | PO: Cardiovascular risk improvement. SO: Proportion of patients achieving treatment goals, quality of life, anxiety. | Baseline and after 12 months. | Effect in cardiovascular risk factors and treatment goals for blood pressure, BMI, and HbA1c. | Reasons for leaving the programme in the TMG were stress associated with the use of the telemonitoring equipment in 3 patients, personal reasons in 7, and inability to handle the equipment in 2 patients. |
Web-based technology | ||||||||||
Norlund et al. 2018 [26] Sweden. | Therapist-guided, tailored Web-based cognitive behavioural therapy. 10 modules with different themes, each containing 2 to 4 treatment steps. | Standard local healthcare. | 239 (IG:117 CG: 122) | Patients with a recent MI and symptoms of depression or anxiety. | 59.6 (8.49) | 67.5 | PO: Anxiety and depression. SO: Cardiac anxiety, depression and suicidal ideation. | Baseline and after 14 weeks. | No effect. | Treatment adherence was low. |
Vieira et al. 2018 [47] Portugal. | A: Virtual reality programme (Kinect) and education on cardiovascular risk factors. B: Paper booklet and education on cardiovascular risk factors. | Education on cardiovascular risk factors. | 46 (IGa:15; IGb:15, CG: 16) | Patients with CAD. | 66 | 100 | PO: Executive function. SO: Quality of life, depression, anxiety, stress. | Baseline and after 3 and 6 months. | Effects in executive function for IG1 (selective attention and conflict resolution ability). | The IG1: 82% participated in the first 3 months and 70% in the last three. The IG2: 90% participated in the first 3 months and 75% in the last 3 months. |
Vieira et al. 2017. Portugal. [48] | A: A virtual reality programme (Kinect) and education on cardiovascular risk factors. B: A paper booklet and education on cardiovascular risk factors. | Education on cardiovascular risk factors. | 46 (IGa:15; IGb:15, CG: 16) | Patients with CAD. | 66 | 100 | PO: Bioimpedancce, BMI, waist to hip circumference, and body composition. SO: Physical activity, eating habits, and lipid profile. | Baseline and after 3 and 6 months. | Effects in waist-to-hip ratio, ingestion of total fat and HDL cholesterol level. | The IG1: 82% participated in the first 3 months and 70% in the last three. The IG2: 90% participated in the first 3 months and 75% in the last 3 months. |
Lear et al. 2015 [36] Canada. | Virtual CR programme with on-line intake forms, scheduled chat sessions with nurse, exercise specialist and dietitian, education sessions, data capture for stress test and blood test results, monthly ask-an-expert group chat. | Simple guidelines for safe exercising and healthy eating, and a list of internet resources. | 78(IG:38 CG: 40) | Patients with CAD. | 60 | 85 | PO: Exercise capacity. SO: Lipid profile, blood glucose, Blood pressure, smoking status, BMI, waist circumference, physical activity, diet, hospital admission and emergency room visits. | Baseline and after 4 and 16 months. | Effect in Exercise capacity. | The median number of website logins per person was 27. 122 one-to -one private chat sessions. |
Devi et al. 2014 [41] England. | Web-based CR. Tailored goals on exercise, diet, emotions and smoking. Online exercise diary. Feedback on physical activity and smoking. Information on CAD-related risk factors. | Care from the GP and attending an annual check of risk factor management with a nurse. | 94 (IG:48 CG: 46) | Patients diagnosed with angina. | 66.27 (8.35) | 74 | PO: Daily average step count, SO: Energy expenditure, duration of sedentary activity, and duration of moderate activity. Weight, blood pressure and body fat percentage, fat and fiber intake, anxiety and depression, self-efficacy, quality of life. | Baseline, 6 weeks after randomization and then 6 months after the 6-week follow-up. | Effect in step-count, energy expenditure, self-efficacy, weight, emotional quality of life score and angina frequency. | The mean number of logins to the program was 18.68, an average of 3 logins per week per participant. Five patients felt trial was too burdensome. |
Vernooij et al. 2012 [43] Netherlands. | Internet-based risk factor management programme and usual care. | Physician at the hospital or general practitioner for risk factor management. | 330 (IG:164 CG: 166) | Patients with atherosclerosis in the coronary (49%), cerebral or peripheral arteries. | 59.9 (8.4) | 75 | PO: The relative change in Framingham heart risk score after 1 year. SO: The absolute changes in levels of risk factors, differences between groups in the change in proportion of patients reaching treatment goals for each risk factor. | Baseline and after 12 months. | No effect (a relative change of −12% in Framingham heart risk score). | 152 patients logged inn at a median of 56 times during the year. Patients (n = 134) sent a median 14 messages, and 131 patients entered a median 7 measurements. The monthly number of logins decreased during the intervention period. |
Reid et al. 2011 [45] England. | Physical-activity plan and access to a website for planning and tracking, and motivational feedback. | Attending a cardiologist and education booklet. | 223 (IG:115 CG: 108) | Patients with ACS. | 56.4 | 84.3 | PO: Physical activity: the average number of steps per day. SO: Self-reported leisure-time physical activity, heart disease health-related quality of life. | Baseline, and after 6 and 12 months. | Effects in physical activity, emotional and physical dimensions of quality of life. | 61.7% of participants completed at least three of the five tutorials. Thirty-seven participants emailed the exercise specialist at least once. |
Lindsay et al. 2009 [46] England. | Moderated web-based discussion groups. | Unmoderated online discussion group. | 108 (IG:54 CG: 54) | Patients with CAD. | 62.9 | 66 | PO: Changes in health behaviour. | Baseline and after 6 and 9 months. | Effects in self-reported diet during moderated phase. | Message writing to moderators decreased from the moderated to the unmoderated phase, while message writing between participants increased. |
Southard et al. 2003 [49] USA | Web-based interactive educational programme | Usual care. | 104 (IG: 53 CG: 51) | Patients with CAD. | 62.3 (10.6) | 75 | PO: Diastolic blood pressure, height, weight, LDL levels, exercise, diet, depression, economic evaluation. | Baseline and after 6 months. | Effect on weight loss and BMI, | On average, the individuals in the IG group logged on to the Web site 58 times over the course of the 6-month intervention, or approximately two times per week. |
Combination | ||||||||||
Widmer et al. 2017 [29] USA. | Web- and smartphone-based CR in addition to standard phase II CR. | A standard phase II CR. | 80 (IG:40 CG: 40) | Patients after PCI for ACS. | 62.5 (10.7) | 78 | PO: CV-related ED visits and readmissions. SO: Weight, blood pressure, heart rate, glucose/HbA1c, lipids, physical activity, diet, quality of life, mood, compliance. | Baseline and after 3 months. | Effect on weight reduction. | 16% continued to use the application after 3 months. |
Wolf et al. 2016 [31] Sweden | A: Person-centered care in addition to a Web- and mobile-based application. B: Person-centered care. | Usual care. | 199 (IGa:37; IGb: 57; CG: 105) | Patients with ACS. | 60 (10) | 75 | PO: Changes in general self-efficacy. SO: Return to work or prior activity level, rehospitalization or death 6 months after discharge. | Baseline and after 6 months. | Effect in general self-efficacy. | The majority used the mobile app rather than the web-based app as the primary source. Patients used the eHealth tool a mean of 38 times during the first 8 weeks and 64 times over a 6-month period. |
Pfaeffli Dale et al. 2015 [33] New Zealand. | Personalized text messages and web-page portal in addition to standard CR. | Standard CR. | 123 (IG:61 CG: 62) | Patients with CAD. | 59.5 (11.1) | 81 | PO: Adherence to recommended health guidelines, subsequent CAD risk probability. SO: Biomedical risk factors, self-reported medication adherence, self-efficacy, illness perception, anxiety and depression, serious adverse event data. | Baseline and after 3 and 6 months. | Effect on adherence to recommended health guidelines and self-reported medication adherence. | All but one in the IG received the Text4Heart programme. High fidelity to the text messaging component. 85% read all their text messages. 79% felt that 24-week programme was the right length. |
Maddison et al. 2015 [34] New Zealand. | Web-site and text messages in addition to community-based CR. | Community-based CR. | 171 (IG:85 CG: 86) | Patients diagnosed with CAD. | 60 (9.3) | 81 | PO: Change in PVO2. SO: Self-reported physical activity, self-efficacy and motivation to exercise, health related quality of life. Economic evaluation. | Baseline and after 24 weeks. | Effect in leisure time physical activity and walking, self-efficacy to be active and the general health domain of quality of life. | 82% of participants read some or all of the HEART text messages and 57% of participants viewed some or all of the video messages on the web-site. On average participants viewed the website once every 2 weeks. |
Frederix et al. 2015 [35] Belgium. | Tele-rehabilitation programme in addition to conventional CR. | Conventional CR. | 140 (IG:70 CG: 70) | Patients entered cardiac rehabilitation for CAD or heart failure. | 61 (9) | 81 | PO: VO2 peak. SO: Accelerometer-recorded daily step counts, self-assessed physical activity, HbA1c, glycemic control, lipid profile, quality of life. | Baseline and after 6 and 24 weeks. | Effect in VO2 peak, self-reported physical activity, and health-related quality of life. | 97% patients reported that the telerehabilitation’s motion sensor was easy to read and use. 89% were willing to use the system after study completion. |
Frederix et al. 2015 [40] Belgium. | Telemoni-toring and personalized feedback in addition to CR. | CR phase II. | 80 (IG:40 CG: 40) | Patients with ACS. | 60 (10) | 83 | PO: Hba1c, lipid profile, VO2 peak, waist circumference, blood pressure, BMI. Re-hospitalization. | Baseline, and after 6 and 18 weeks. | Effects in HbA1c, HDL, VO2 peak. |  |
Varnfield et al. 2014 [42] Australia. | Text messages and web-based smartphone application. | Traditional center-based CR. | 120 (IG:60 CG: 60) | Post-MI patients referred to CR. | 55.7 (10.4) | 82 | PO: Uptake, adherence and completion of a CR programme. SO: Modifiable lifestyle factors, biomedical risk factors, waist circumference, lipid profile, health related quality of life. | Baseline, 6-weeks and 6-months. | Effects in uptake, adherence and completion rates, quality of life, blood pressure. | Â |