Technology-based comprehensive cardiac rehabilitation therapy for women in a middle-income setting: a randomized...

Women are under-represented in cardiac rehabilitation (CR), especially in lower-income settings. This study tested Technology-bAsed Cardiac rehabilitation Therapy (TaCT) on functional capacity, risk factors, quality of life (QoL; MacNew), heart-health behaviours (e.g. Global Physical Activity Questionnaire), cardiac symptoms (e.g. angina), and morbidity (e.g. hospitalization and procedure) in women.

Single-centre, single-blind, two parallel arms (1:1 SNOSE) randomized superiority trial, undertaken in an Indian outpatient cardiology department, where women with stable cardiac disease and smartphone access were recruited. TaCT was compared with standard care (CR rare), with assessments conducted before the intervention, and 6 months later. The 6-month comprehensive intervention was delivered via several technologies. Exercise prescriptions were based on an Incremental Shuttle Walk Test (ISWT; primary outcome). Analyses were based on intention-to-treat. Fifty women were randomized to intervention, and 50 to control (n = 89; 89.0% retained). There were few tobacco users. Results for the following outcomes favoured intervention: functional capacity [ISWT effect size = 0.3 (95% confidence interval = 1.0 to -0.2), P = 0.002; Duke Activity Status Index P < 0.001; Sit-to-Stand P = 0.003], QoL (global and all subscale P's < 0.001), and heart-health behaviours (exercise P < 0.001; medication adherence P = 0.02), and anxiety (P = 0.002). There were no significant differences in blood pressure, waist circumference, or cardiac symptoms. Three participants in the intervention group experienced morbidity and 1 suffered mortality and 9 in controls experienced morbidity only.

The TaCT program significantly improved functional capacity, QoL, heart-health behaviours and anxiety in women with cardiovascular disease in a middle-income country, demonstrating the potential of technology-based CR tailored for women in these settings.

CTRI/2021/07/035197 URL: https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=51810&EncHid=79231.15408&modid=1&compid=19.