Background:

Coronary artery disease (CAD) remains the leading cause of death world-wide. Despite significant advances in therapeutic approach, morbidity, mortality as well as the readmission rate among patients with CAD remains high. Even though lifestyle change and risk factor control is associated with a significantly improved prognosis, 70% of patients fail to make the minimal behavior adjustments for an effective risk reduction. In recent years, new smartphone- based applications have emerged to improve guideline adherence.

Objectives: 

The purpose of this study was to investigate the effect of a digital secondary prevention program (Vantis) on therapy adherence for patients with CAD. Vantis consisted of the smartphone app VantisTherapy, an integrated blood pressure monitor and a smartwatch. 

Methods: 

Vantis is a program to support patients with CAD to accomplish recommended lifestyle changes based on current ESC-guidelines. The 10-30-minute daily program includes, amongst others video-guided exercises, digital nutrition coaching, medication tracking and educational units. Vantis also tracks bodyweight, food intake, blood pressure, heart rate and daily minutes of moderate to intense exercise through the connected devices and manual inputs by patients. It then provides personalized feedback to improve a patient’s adherence to the guideline recommendations.

The primary outcome was evaluating the efficiency of Vantis to improve patients` behavior according to the ESC guidelines with respect to physical activity (goal: 150min per week), nutrition (goal: Mediterranean diet), smoking (goal: smoke free), medication (goal: 100% confirmed intake), and blood pressure monitoring (goal: 8/14 days). The aggregate is called therapy adherence, normalized for 0-100% and measured at week 12 of the therapy. It was evaluated for all patients with an intention to treat.

The secondary outcome was engagement and program completion (based on completed activities with the app and trailing fourteen-day activity), change in systolic blood pressure and Vantis bio age (as indicator for cardiovascular event risk).

Results

From August to October 2021, 34 patients with CAD were included in the study. 76% of the starters completed the therapy. The app was used 5,7 days per week on average. Active users completed 8,9 therapy related activities per day on average. The number of activities converged to 8,4 by week 8 and then remained constant on this high level.

Therapy adherence was 46% at baseline across all 34 patients. It improved by 30% until the end of week 12 assuming no effects for drop-outs. Looking only at active participants, the therapy adherence was 44% at baseline and increased by 56%. In total, 91% of patients improved their individual therapy adherence.

80% of the patients improved their systolic blood pressure. The systolic blood pressure of patients with elevated blood pressure decreased by 8.2 mmHg on average.

Also the Vantis bio age decreased by 13 years on average (provided that the improved therapy adherence remains stable).

Conclusion

The evaluation of the data reveals that smartphone-guided secondary prevention has a clinically relevant effect. Statistical significance is expected in a randomized controlled setup with 64 patients.