Heart attack is the leading cause of death worldwide and is associated with substantial public health costs. When an individual has a heart attack, immediate treatment generally requires urgent revascularization, followed by a comprehensive program to reduce the risk of future cardiac events through medication and lifestyle changes. Cardiac Rehabilitation (CR) following a heart attack generally involves exercise, personalized coaching, and therapy. Strong evidence suggests that exercise-based CR can reduce mortality and the risk of having another heart attack. However, low referral rates and low completion rates continue to impede the effectiveness of these programs. Digital health applications have risen in popularity due to their convenience and other factors. However, are they effective when it comes to bridging gaps in care and facilitating care transitions?
In October 2021, the results of a pilot study were published evaluating the impact of a modified smartphone application on outcomes such as 30-day hospital readmission, outpatient follow-up, and CR enrollment for inpatients undergoing percutaneous coronary intervention (PCI). This single-arm study enrolled participants in the intervention group between February 2018 and May 2019 and used a historical control group for comparison. The study found that outpatient follow-up and CR enrollment rates were larger with the use of the app. No short-term increase in readmissions was found, possibly indicating that patients did not use the app to replace necessary care.
Although promising, the study did contain some selection bias. For example, eligible participants were required to own a smartphone. In addition, the use of a historical control group for comparison limited the scope of clinical events to a specific health system. However, the results of this study are essential for multiple reasons, including the finding that cardiovascular patients willingly used the app and were able to be set up with the app in an inpatient setting. Future randomized controlled trials should focus on how increased engagement with similar applications can translate to improved clinical outcomes.