Background: Previous studies have documented a favorable effect of cardiac rehabilitation (CR) on patients undergoing percutaneous coronary intervention (PCI). However, participation in CR is sub-optimal, especially in China. Innovative models of CR are needed to improve participation. The present study assessed the effect of a mobile phone-based CR (MBCR)program on exercise capacity and clinical outcomes in patients undergoing PCI.
Methods: Totally 212 patients following PCI referred to the CR clinic of Chinese PLA General Hospital, between Jul, 2015 and Apr, 2016, were divided into 2 groups, to participate in MBCR (n=107) or usual care program (control, n=105). Individualized exercise prescription and educational materials were sent to the participants in the MBCR group by the App named “Heartguard” regularly. Cardiopulmonary exercise testing and adverse events were evaluated at baseline and after 12 months.
Results: There is no statistical difference of the baseline demographic, clinical, and functional parameters between both groups. Compared with those in the control group, participants in the MBCR group showed a greater increase in peak exercise capacity (+0.74 vs +0.08 METs,+16.4% vs +4.5%, p=0.000), VO2 at anaerobic threshold (+0.84 vs -1.44 mL O2·kg-1·min-1, +26.5% vs -2.2%, p=0.001) , and dVO2/dWR (+0.16 vs -1.1 mL O2·min-1·W-1, +14.5% vs -9.2%, p=0.005) with a greater decrease in VE/VCO2 slope (-1.82 vs + 0.41, -6.0% vs +1.3%, p=0.001) in 12 months. Range of blood pressure lowering, angina symptoms and life quality in both groups were similar, but the proportion of smoking participants in the MBCR group was lower (1.0% vs 6.3%, p=0.048). A lower incidence of unscheduled target vessel revascularizations (0/107 vs 7/105, p=0.007), rehospitalizations (1/107 vs 12/105, p=0.001), worsening angina (10/107 vs 21/105, p=0.022), and combined endpoint (9/107 vs 23/105, p=0.005), was also found in the MBCR group. Multivariable analysis revealed MBCR is the only predictor associated with the combined endpoint (B=-1.102, p=0.015).
Conclusions: The MBCR program we studied is associated with better exercise capacity, less smoking and less adverse cardiovascular events. It has the potential to improve CR participation in patients following PCI.