Effectiveness of Mobile Health Augmented Cardiac Rehabilitatioon Clinical Outcomes among Post-Acute Coronary Syndrome Patients: A Randomized Controlled Trial

Objective: To determine the effectiveness of mobile health augmented cardiac rehabilitation on clinical factors among post-acute coronary syndrome (post-ACS) patients. Method: A randomized controlled trial was conducted at Armed Forces Institute of Cardiology, Rawalpindi. This study was conducted on inpatients post-ACS patients. Patients were randomly allocated into the intervention group (counselling, short text messages, and standard post-ACS care) or the control group (standard post-ACS care). Clinical factors assessed were blood pressure, body mass index, the number of days of hospitalization, no of readmissions, and major adverse clinical events (MACE) within 180 days post-ACS. Data were collected thrice for six months follow-up periods (baseline, 12 and 24 weeks). Result: The mean days of hospitalization were reduced significantly of the intervention group compared to the control group (02.55, 95%CI: 02.13, 02.98 versus 04.07, 95%CI: 02.96, 05.17, p-value=0.033) at 12 weeks follow up. Also, at 24 weeks follow up, the intervention group reduced the number of readmission days compared to the control group (02.62, 95% CI: 02.00, 03.24, versus 03.71, 95%CI: 02.68, 04.74, p-value=0.041). Twenty-nine (43.94%) patients of the control group and 18 (24.32%) of the intervention group developed MACE at 12 weeks follow up (p-value: 0.016). While at 24 weeks follow up, 8 (16.33%) of the control group and 7 (9.86%) of the intervention group suffered MACE (p-value: 0.196). Conclusion: The MCard positively impacts the clinical outcomes. It has significantly decreased the likelihood of readmission and decreased the number of days of hospitalization among the MCard group compared to the usual care group. This trial has found an overall lower incidence of MACE (composite of readmission, myocardial re-infarction, heart failure and death) among the MCard group than usual care.