i-CARE: a smartphone-based intervention to enhance cardiac rehabilitation in coronary artery disease-a randomized...

The global shortage of healthcare professionals creates challenges in managing chronic diseases. This study evaluated a remotely delivered, theory-based self-care support intervention, 'Internet-based CArdiac Rehabilitation Enhancement (i-CARE)', delivered through a smartphone application to enhance self-management in patients with coronary artery disease (CAD).

In this assessor-blinded, two-arm randomized controlled trial conducted at two regional hospitals in Hong Kong, community-dwelling adults with angiographically confirmed CAD were randomly assigned (1:1) to standard care or the i-CARE intervention. i-CARE included personalized risk assessment, skill-building, and app-based support to improve self-care behaviours. The primary outcome was change in CAD self-care behaviours; secondary outcomes were self-reported health status, health-related quality of life (HRQoL), physiological, and biomarkers. Of 294 participants randomized (n = 147 per group), the i-CARE group showed significant greater improvements in self-care maintenance [β = 4.055, 95% confidence interval (CI) 1.420-6.691, P = 0.003] and self-care confidence (β = 5.609, 95% CI 1.089-10.129, P = 0.015) at 3 months, sustained at 6 months. For secondary outcomes, the intervention also resulted in significant reductions in systolic (β = -3.725, 95% CI -7.322 to -0.128, P = 0.042) and diastolic (β = -2.153, 95% CI -4.228 to -0.079, P = 0.042) blood pressure and improvements in HRQoL at 3 months (β = 0.208, 95% CI 0.073-0.343, P = 0.003), with persistent benefits for diastolic blood pressure and HRQoL sustained at 6 months. No significant differences were observed for cardiac-specific health status, blood glucose, lipid profile, or waist-to-height ratio.

Remotely delivered i-CARE intervention effectively promote self-care among CAD patients and may help address critical healthcare workforce shortages, while also conferring secondary benefits in blood pressure and HRQoL.