Using Mobile Health Apps to Improve Outcomes After Hospitalization for Ischemic Heart Disease

NYU Langone’s Rehabilitation at Home Using Mobile Health in Older Adults After Hospitalization for Ischemic Heart Disease trial, also known as RESILIENT, is a clinical trial that aims to evaluate whether cardiac rehabilitation administered through a mobile health application improves functional capacity in people age 70 years and older with ischemic heart disease.

Among older adults with ischemic heart disease, participation in ambulatory cardiac rehabilitation remains low despite decades of evidence about its benefits. By recent estimates, fewer than two thirds of eligible patients are referred, and even among those referred, only half attend the first session.

In addition to barriers faced by the general population (limited facilities, competing time demands, high out-of-pocket costs, prolonged wait time for space), older adults face particular barriers including lack of transportation, physical limitations, and cognitive impairments that make it especially difficult to use existing cardiac rehabilitation paradigms.

Mobile health–enabled cardiac rehabilitation (mHealth-CR), which involves delivery of rehabilitation via portable electronic devices, could be beneficial to the older adult population with ischemic heart disease.

mHealth-CR involves software with several key features intended to promote healthy behaviors, including features that allow the users to document exercise, measure risk factors such as blood pressure (BP), view educational materials, monitor physical activity with wearable devices, and communicate electronically with clinicians.

What Is the RESILIENT Trial?

The RESILIENT trial seeks to test whether an mHealth-CR platform that contains these elements improves functional capacity compared with the current standard of care.

Mobile Health Cardiac Rehabilitation Software

Our intervention uses Moving Analytics, a mobile health software application that is designed to deliver mHealth-CR on portable electronic devices.

For the purposes of our study, participants are provided with a tablet computer for the duration of the study. The Moving Analytics platform contains the key features of mHealth-CR described above and has the capability to automatically synchronize with a BP cuff and a wearable activity monitoring device (both are provided to RESILIENT study participants).

The mHealth-CR software is paired with weekly telephone contact by a trained exercise therapist, in order to review activity achieved and to set goals for the following week.

Study Design

Participants who are enrolled in the study are randomly assigned to one of two groups: a group that receives the mHealth-CR intervention or a group that receives usual care. They are interviewed at baseline and at three months.

Participants in both groups are also able to attend traditional, facility-based cardiac rehabilitation, in accordance with currently accepted best practice guidelines. Study enrollment occurs over approximately 42 months with an expected minimum of 3 months follow-up per participant.

RESILIENT Leadership Committee

The RESILIENT Leadership Committee includes John A. Dodson, MD, MPH, NYU Langone principal investigator; Sarwat Chaudhry, Yale School of Medicine principal investigator; and co-investigators Judith S. Hochman, MD; Caroline S. Blaum, MD; Antoinette M. Schoenthaler EdD; Samrachana Adhikari, PhD; and Thomas M. Gill, MD.

NYU Grossman School of Medicine is the Clinical Coordinating Center. Enrollment takes place at three locations: NYU Langone Medical Center—comprising Tisch Hospital and Kimmel PavilionNYU Winthrop Hospital, and Yale New Haven Hospital.

RESILIENT Funding

The RESILIENT trial is funded through a sponsored grant from the U.S. National Institute on Aging (NIA) of the National Institutes of Health (NIH).

References

Aragam KG … Gurm HS. Gaps in referral to cardiac rehabilitation of patients undergoing percutaneous coronary intervention in the United States. J Am Coll Cardiol. 2015. DOI.

Varnfield M … Walters DL. Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: Results from a randomised controlled trial. Heart. 2014. DOI.

Dunlay SM … Roger VL. Barriers to participation in cardiac rehabilitation. Am Heart J. 2009. DOI.

Mazzini MJ … Balady GJ. Effect of an American Heart Association Get With the Guidelines program-based clinical pathway on referral and enrollment into cardiac rehabilitation after acute myocardial infarction. Am J Cardiol. 2008. DOI.

Thomas RJ … Spertus J. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services. Circulation. 2007. DOI.

Contact Us

If you are interested in receiving more information about the RESILIENT trial, please email resilient@nyulangone.org.