Background

Coronary artery disease (CAD) is the leading cause of death in Europe and worldwide. In addition to the administration of several effective drugs and coronary revascularization, a healthy lifestyle that includes regular physical activity, following a healthy diet, and avoiding tobacco consumption can have a major impact on preventing secondary cardiovascular events.

However, the compliance among the patients to change their lifestyle is low. Recent data indicate that only 30% of CAD patients follow the lifestyle recommendations of the current guidelines. There are different causes that may lead to this lack of compliance.

One of the most important reasons might be the difficulty to implement the required changes into everyday life. The wide adoption of smartphones offers new opportunities to integrate secondary prevention into the daily routine of CAD patients and guide them towards a healthier lifestyle.

Objectives

The purpose of this study was to first identify the patient needs for a smartphone-guided secondary prevention (SGSP). Based on these needs, we developed an app to integrate SGSP into their everyday life. We then tested if the app could achieve lifestyle changes and a gain of disease specific knowledge amongst CAD patients.

Methods

Twenty patients completed a survey on their specific needs with regard to secondary prevention and monitoring of vital parameters. Based on these responses, a SGSP app was developed, which displays a daily program of 15 minutes including 1) video-guided exercises, 2) video sessions with background information about CAD, and 3) a tool to record blood pressure and heart rate once a day.

The SGSP app was tested with the primary outcome of 28-day adherence (usage of the app for at least 20 days within the 28-day study). The secondary outcome was a composite of 1) self-reported behavioral changes (increased physical activity and implemented a healthier diet), 2) gain of knowledge about cardiovascular risk factors, and 3) an increase in quality of life. Secondary endpoints were assessed before and after the study period of 28 days.

Results

66 patients were assessed for eligibility for the SGSP app. 43 patients (65%) were included into the study based on smartphone availability and willingness to participate. 17 patients (40%) used the app continuously for 28 days. From this group, 82% were physically more active and 59% improved their dietary habits. Usage of the SGSP app was associated with a relevant knowledge gain regarding cardiovascular risk factors (70% physical activity, 59% healthy diet).

There was no significant difference between the outpatients and hospitalized patients (50% vs 33%, 95% CI, p = 0.34) or men and women (42% vs. 30%, 95% CI, p = 0.71) regarding adherence to the app. Out of the 26 patients who discontinued the app, 20 mentioned reasons that can be addressed through personalization and technical improvements of the SGSP app. Of note, 88% of the patients who successfully finished the 28-day program showed interest for continued use of the app.

Conclusion

This study reveals that smartphone apps can facilitate secondary prevention for CAD patients. Regular use of the app increased physical activity and improved dietary habits of patients suffering from CAD. Long-term smartphone app-guided secondary prevention could be a novel tool to reduce the burden of cardiovascular disease.