For patients with coronary heart disease who underwent percutaneous coronary intervention (PCI), interactive mobile health (mHealth) application EVITE helped patients improve their lifestyle and adhere to changes. .
According to a study published in JMIR mHealth and uHealththese lifestyle changes include adhering to a Mediterranean diet, improving the frequency of healthy food intake, increasing physical activity, and quitting smoking.1 The EVITE app also helped patients increase their knowledge about healthy lifestyle and cardiovascular risk factor (CVRF) control, and patients reported overall satisfaction with the app and improved quality of life. The app has multiple components (website, messages, email, phone) to encourage users to adhere to lifestyle modifications, associate medication with these daily activities, and set medication times. It was helpful.
“Self-monitoring and recording in an app increases patients' awareness of their lifestyle behaviors, and motivation drives the initiation and persistence of behavioral changes over time,” the authors said.
Coronary heart disease is the leading cause of death worldwide, and secondary prevention is essential to reduce the risk of further coronary artery disease. As defined by Yale Medicine, PCI is a nonsurgical procedure that treats coronary artery blockages by opening the narrowed or blocked portion of the coronary artery and restoring proper blood circulation to the heart.2 Less invasive than coronary artery bypass surgery, the procedure is usually performed through small arteries in the wrist. Approximately 900,000 PCIs are performed annually in the United States alone, and most patients are discharged from the hospital within 24 hours and return to normal daily life after a minimal recovery period.
In this randomized controlled trial, 128 participants were assigned to an mHealth intervention group (n = 67) or a control group receiving standard medical care (n = 61). Of this group, 71.9% were male and the mean (SD) age was 59.49 (8.97) years. The app facilitated goal setting and self-monitoring of lifestyle and CVRF, provided educational resources on healthy living, and provided motivational feedback on achievements and areas for improvement.
After nine months, patients in the mHealth group showed significant improvements in lifestyle compared to the control group across several parameters. This study includes patients who underwent PCI in Spain between November 2019 and June 2022, so any precautions taken during the COVID-19 pandemic will not be identified during the study. It is important to note that this may have influenced lifestyle changes.
Adherence to the Mediterranean diet was determined using the 14-point Mediterranean Adherence Score, with scores below 9 considered low adherence and scores above 9 high adherence. At baseline, adherence scores were similar in the mHealth (7.24) and control groups (7.52). After 9 months, the mean (SD) score of patients who used the mHealth app was 11.83 (1.74) points, and the mean score of the control group was 10.14 (2.02) points (P < .001). Proportionally more patients in the mHealth group adhered to the Mediterranean diet with a score above 9 points (90%) compared to the control group (75%). P = .02).
Using a food frequency questionnaire, researchers found that the group using the app had significantly reduced consumption of red meat and industrial pastries compared to the control group. . Meanwhile, patients using the app also significantly increased their intake of vegetables, fruits, and whole grain cereals.
Another similar trend was that the group using the EVITE app increased their physical activity significantly more than the control group, as reported by patients. At baseline, the mHealth group was already slightly more active than the control group, about 35 minutes per week, but this difference increased significantly to nearly 150 minutes per week between both groups at 9 months. . Patients in the mHealth group increased the mean (SD) amount of physical activity to 619.14 (318.21) minutes/week compared to 471.70 (261.43) minutes/week for patients in the control group (P = .007).
At baseline, 33 mHealth patients and 26 control patients were active smokers. After 9 months, 25 patients who used the app had quit smoking compared to 11 patients who did not use the app (P = .01).
A validated scale consisting of 24 items and 5 response options was utilized to assess participants' understanding of CVRF and healthy lifestyle practices, with a maximum score of 120 points. A high level of knowledge was defined as answering 75% or more of the items correctly or receiving a score of 90 or higher. Participants in the mHealth group demonstrated significantly greater understanding of healthy lifestyle practices and cardiovascular risk factor management after using the app compared to participants in the control group, with mean (SD) scores of It was 118.70 (2.65) points compared to 111.25 points for the group. in the control group it was (9.05) points (P < .001). However, by the end of the follow-up period, treatment adherence showed similar improvements in both groups, and no statistically significant differences were observed between the groups.
“Knowledge of the risk factors for this disease is essential for patients to decide to adopt healthy lifestyle behaviors,” the authors said. “But people also need motivation to incorporate such behaviors into their daily lives. Innovative mHealth technologies can help achieve both objectives by increasing patient knowledge and motivation.”
Regarding quality of life, patients in the intervention group had significantly better scores on the physical component compared to the control group, but both groups had similar scores on the mental component. Although the mHealth group had slightly better scores on the well-being index, the difference did not reach statistical significance. Regarding overall satisfaction with health care, patients in the mHealth group rated their experience higher than patients receiving standard care, with mean (SD) scores of 48.22 (3.89) out of 50, respectively. It was 46.00 (4.82) points. Point (P = .002).
“Further studies with long-term follow-up that analyze mortality and heart disease hospitalizations are needed to investigate the impact of smartphone interventions on people who have experienced coronary artery disease, as they may be a secondary prevention strategy. “This is an important criterion for success, as it allows us to establish the clinical significance of the results,” the authors concluded. “Cost analysis is also required to facilitate the general use of these tools, their implementation, and feasibility.”
References
- Bernal-Jiménez Me, Calle G, Gutiérrez-Barrios A, et al. Effectiveness of an interactive mhealth app (EVITE) in lifestyle modification after coronary events: a randomized controlled trial. JMIR Mhealth Uhealth. 2024;12:e48756. doi:10.2196/48756
- Percutaneous Coronary Intervention (PCI). Yale Medicine. Accessed April 24, 2024. https://www.yalemedicine.org/conditions/percutaneous-coronary-intervention-pci