Effectiveness of Mobile Health Augmented Cardiac Rehabilitation on Behavioural Outcomes among Post-acute Coronary Syndrome Patients: A Randomised Controlled Trial.

Objective: To determine the effectiveness of mobile health augmented cardiac rehabilitation (MCard) on behavioural factors among post-acute coronary syndrome (post-ACS) patients.

Study Design: Randomised controlled trial.

Place And Duration Of Study: Armed Forces Institute of Cardiology (AFIC), from January 2019 till March 2021.

Methodology: Post-ACS patients were assigned to one of two groups: intervention (counselling, brief text messages, and standard post-ACS care) or control (no intervention) (standard post-ACS care). Healthy eating (Healthy eating assessment tool) and physical activity (IPAQ tool), medication compliance, smoking, salt intake, blood pressure (BP), and weight self-monitoring were assessed as behavioural factors. Data were collected three times for a six-month follow-up period (baseline, 12 and 24 weeks).

Result: At 12 weeks, 121 (76.62%) of the 160 patients enrolled patients (80 in each group) were analysed; and at 24 weeks, 119 (74.38%) were analysed. Mean MET score at baseline was 1170 control vs. 1161 intervention (p = 0.940), at 12 weeks 826 vs. 934 (p = 0.390); and at 24 weeks was 925 vs. 1454 (p = 0.007). Healthy eating value at baseline was 36.43 control vs. 36.38 intervention (p =0.897), at 12 weeks 38.76 vs. 40.98 (p<0.001); and at 24 weeks 40.12 vs. 43.54 (p <0.001). There was also a significant difference in salt intake (p = 0.008) and healthy diet (p = 0.012), but not in medicine compliance, smoking behaviour, self-monitoring of BP and weight.

Conclusion: The MCard positively impacts the post-ACS participants' behaviours in terms of physical activity, healthy eating, and salt restriction. MCard evidenced as a feasible intervention in terms of having lasting behaviour modification among this vulnerable patient population. Key Words: Acute coronary syndrome, Myocardial infarction, Cardiovascular diseases, Cardiac rehabilitation, Healthy diet, Physical activity, Smoking, Tobacco, Telemedicine, Lifestyle modification.