Relationship Between Clinical, Psychological, Physiological, and Technical Parameters during Digital-Health -assisted Cardiac Rehabilitation Including Home Training

Introduction: Home and telehealth-based interventions are increasingly used in cardiac rehabilitation (CR), a multidisciplinary model of health care. Digital tools such as wearables or digital training diaries are expected to support patients to adhere to recommended lifestyle changes, including physical exercise programmes. As previously published, the EPICURE study analysed the efects of digital tools, i.e., a digital training diary, adherence monitoring, and wearables, on exercise capacity during outpatient CR phase III (OUT-III) which includes an approximately 12-week home training phase [1]. Te study encompassed 149 Austrian patients, of which 50 utilized digital tools. Te present paper takes a deeper look into the EPICURE data to better understand a) the relation between the use of digital tools and various psychological, clinical, and physiological parameters, and  b) the relation between these parameters and the improvement of exercise capacity during cardiac rehabilitation.

Methods: For this work, we analysed questionnaires concerning the patients’ CR and data acquired by digital tools during CR. On all these parameters we performed two analyses: 1) Comparison of the two groups with and without digital tools and  2) correlation with the change in the maximum workload as achieved during the exercise stress test. If data pre and post OUT-III were available, the change in the respective parameter during OUT-III was determined and group analyses and correlation were applied on a) data pre OUT-III, b) data post OUT-III, and c) the change during OUT-III.

Results: We found signifcant improvements in quality of life in both groups with a p-value P=.012 for patients with and P=.004 for patients without digital tools. However, no signifcant diferences between the improvements of patients with or without digital tools was identifed (P=.53). Patients with digital tools perceived signifcantly higher competence during CR (P=.049), and they anticipated higher cardiac risks if non-adherent to physical activity (P=.028). Although, the overall subjectively reported adherence was not signifcantly diferent in the two groups, specifc items difered: Patients with digital tools were signifcantly less likely not to do their exercises when they were tired and to forget their exercises with P=.003 for both items. Concerning reasons for (non-) adherence, patients with
digital tools reported signifcantly more often to do their exercises because they enjoyed them (P=.012), whereas they were signifcantly less likely a) to stop exercising when muscular pain was worse (P=.012) and b) to continue doing their exercises when muscular pain improved (P=.024). Finally, patients who reported a high level of concrete planning achieved signifcantly higher improvements in exercise capacity (P=.039).

Conclusion: We conclude that digital tools can support adherence to exercise training recommendations during facility- as well as home-based out-patient CR. Tis comprehensive analysis provides valuable insights into the multifaceted impact
of digital tools on outpatient cardiac rehabilitation including home training, shedding light on factors infuencing patient outcomes and adherence in the evolving landscape of digital health interventions.