“Heart Track”: A Novel Patient-Activated Cardiac Rehabilitation Care Model

Year Submitted: 2025
Published Date: 17 April 2025

Tags: Care Continuum, Chronic Care, Primary Care, Applied/Translational Research, Qualitative Research

About this Content

Aims

To evaluate effectiveness and non-inferiority of a novel mobile application based cardiac rehabilitation (CR) Heart Track, compared to traditional CR, for patients who underwent percutaneous coronary intervention (PCI) following acute myocardial infarction (MI).

Background

Cardiovascular vascular diseases (CVDs) are the leading cause of mortality and morbidity globally (Jayaraj et al., 2018).1 Myocardial infarction (MI) is the most common form of CVD (Mendis et al., 2015).2 An MI occurs when a coronary artery gets partially or fully occluded resulting in a reduction in the blood flow to the cardiac muscles causing them to become infarcted (Goldstein et al., 2000).3 Post-MI, most patients undergo a percutaneous coronary intervention (PCI). The reoccurrence of an MI is high if cardiovascular risk factors are not managed adequately (Piepoli et al., 2014).4 International guidelines have recommended cardiac rehabilitation (CR) after a PCI (Piepoli et al., 2014).4 This helps to reduce all-cause mortality, cardiac mortality, and sudden cardiac deaths (Clark et al., 2005 & Anderson & Taylor, 2014). 5,6

Despite the multifaceted benefits of CR, uptake and adherence to CR remain low. In Tan Tock Seng Hospital (TTSH), CR completion rate amongst post-PCI cardiac patients was 19% in 2016. Distance from CR centre, poor social support, lack of knowledge of the referral process by physicians are some of the barriers cited by literature affecting the uptake and adherence to CR (Ruano-ravina et al., 2016).7

Methods

This is a single-blinded randomized controlled trial. Patients post-PCI following MI were assessed for eligibility by physiotherapies in CR clinics. 34 participants were recruited. Block randomization was conducted for allocation into intervention (HT-group, n=17) and control groups (CR-group, n=17). HT-group participants were expected to use HT device three times a week, while CR-group participants attended weekly centre-based CR programme with advice to continue with similar home-based sessions twice weekly. After 8-12 weeks of control or intervention settings, all subjects underwent 6-minutes’ walk test (6MWT) to evaluate aerobic capacity and endurance, done by a blinded assessor (physiotherapist).

Results

There were statistically significant increases in 6MWT results pre- and post-intervention for HT-group (p=0.02), but not for the CR-group (p=0.26). Notably, 10 participants in HT-group achieved minimal clinically important difference (MCID) for 6MWT distance compared to 7 participants from CR-group, though the difference.

Clinical Impact box:
• This study is the first to introduce and evaluate a novel mobile application-based cardiac rehabilitation in Asia countries.
• Findings highlight the potential of Heart Track as an alternative to traditional cardiac rehabilitation.

Clinical Implications:
• This study supports the future mainstream implementation and adoption of mobile application-based cardiac rehabilitation for patients undergoing percutaneous coronary intervention post myocardial infarction.
• This data may guide efforts and provide potential ways to improve the uptake and adherence of cardiac rehabilitation of such patients in Singapore.

Conclusion

Evaluation of our novel mobile application based CR suggests that it can be a viable alternative to traditional CR. Heart Track is safe, effective and reported to have good user satisfaction. Future studies could evaluate how Heart Track affects adherence and its influence on clinical outcomes, as high adherence is crucial to understanding the efficacy of rehabilitation programmes.

Lessons Learnt

Agility and perseverance to complete the trial.

Additional Information

TTSH Value Festival Merit Award 2021; NHIP award 2021

Keywords

Cardiac rehabilitation

Innovators' Details

Connect with this contributor!

Ashton Neoh Eng Chuan - Eng_chuan_neoh@ttsh.com.sg

Project Attachment