Rationale and Design of the mTECH-Rehab Randomized Controlled Trial: Impact of a Mobile Technology Enabled Corrie Cardiac Rehabilitation Program on Functional Status and Cardiovascular Health.

Jie Ding, Nancy Molello, Jeanmarie Gallagher, Ashley Broderick, Alexandra Bush, Mansi Nimbalkar, Zane MacFarlane, Patrick Dunn, Erin D Michos, Yvonne Commodore-Mensah, Nino Isakadze, Chang H Kim, Seth S Martin, Erin M Spaulding, Yumin Gao, Nichol McBee, Daniel F Hanley, Lena Mathews, Kerry J Stewart, Francoise A Marvel

Journal: Journal of the American Heart Association 2024;13(2):e030654

PMID: 38226511

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Abstract

BACKGROUND

Cardiac rehabilitation (CR) is an evidence-based, guideline-recommended intervention for patients recovering from a cardiac event, surgery or procedure that improves morbidity, mortality, and functional status. CR is traditionally provided in-center, which limits access and engagement, most notably among underrepresented racial and ethnic groups due to barriers including cost, scheduling, and transportation access. This study is designed to evaluate the Corrie Hybrid CR, a technology-based, multicomponent health equity-focused intervention as an alternative to traditional in-center CR among patients recovering from a cardiac event, surgery, or procedure compared with usual care alone.

METHODS

The mTECH-Rehab (Impact of a Mobile Technology Enabled Corrie CR Program) trial will randomize 200 patients who either have diagnosis of myocardial infarction or who undergo coronary artery bypass grafting surgery, percutaneous coronary intervention, heart valve repair, or replacement presenting to 4 hospitals in a large academic health system in Maryland, United States, to the Corrie Hybrid CR program combined with usual care CR (intervention group) or usual care CR alone (control group) in a parallel arm, randomized controlled trial. The Corrie Hybrid CR program leverages 5 components: (1) a patient-facing mobile application that encourages behavior change, patient empowerment, and engagement with guideline-directed therapy; (2) Food and Drug Administration-approved smart devices that collect health metrics; (3) 2 upfront in-center CR sessions to facilitate personalization, self-efficacy, and evaluation for the safety of home exercise, followed by a combination of in-center and home-based sessions per participant preference; (4) a clinician dashboard to track health data; and (5) weekly virtual coaching sessions delivered over 12 weeks for education, encouragement, and risk factor modification. The primary outcome is the mean difference between the intervention versus control groups in distance walked on the 6-minute walk test (ie, functional capacity) at 12 weeks post randomization. Key secondary and exploratory outcomes include improvement in a composite cardiovascular health metric, CR engagement, quality of life, health factors (including low-density lipoprotein-cholesterol, hemoglobin A1c, weight, diet, smoking cessation, blood pressure), and psychosocial factors. Approval for the study was granted by the local institutional review board. Results of the trial will be published once data collection and analysis have been completed.

CONCLUSIONS

The Corrie Hybrid CR program has the potential to improve functional status, cardiovascular health, and CR engagement and advance equity in access to cardiac rehabilitation.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT05238103.

Address: Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA.; Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA.; Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA.; Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA.; Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA.; Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA.; Johns Hopkins University School of Nursing Baltimore MD USA.; Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD USA.; Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA.; Johns Hopkins Center for Health Equity Baltimore MD USA.; Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA.; Johns Hopkins University School of Nursing Baltimore MD USA.; Johns Hopkins Center for Health Equity Baltimore MD USA.; Center for Health Technology and Innovation, American Heart Association Dallas TX USA.; Department of Neurology Johns Hopkins University School of Medicine Baltimore MD USA.; Department of Neurology Johns Hopkins University School of Medicine Baltimore MD USA.; Division of Neurosurgery, Department of Surgery Johns Hopkins University School of Medicine Baltimore MD USA.; Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MD USA.; Ginsburg Institute for Health Equity, Nemours Children's Health Orlando FL USA.; Department of Neurology Johns Hopkins University School of Medicine Baltimore MD USA.; Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA.; Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA.; Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA.; Johns Hopkins Center for Health Equity Baltimore MD USA.; Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA.; Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA.; Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA.; Johns Hopkins Center for Health Equity Baltimore MD USA.; Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD USA.

DOI: 10.1161/JAHA.123.030654

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MeSH Terms: Humans, Cardiac Rehabilitation, Quality of Life, Functional Status, Myocardial Infarction, Cholesterol