The impact of a smartphone enabled application on participation in cardiac rehabilitation and understanding barriers to success: a cohort study (Preprint)

BACKGROUND Poor patient uptake of cardiac rehabilitation (CR) remains a challenge for multiple reasons including geographic, time, cultural, cost and psychological constraints. OBJECTIVE We evaluated the impact on CR participation associated with the introduction of a smartphone enabled app (Cardihab) for patients declining conventional CR and investigated the barriers to participation in CR. METHODS 204 consecutive patients were offered CR post angioplasty, 99 in phase 1 (conventional CR) and 105 in phase 2 (app-based CR for those declining conventional CR). Patients were followed throughout a 6-week CR program in phase 2 and participation rates compared for both groups. Patients declining to participate in either form of CR were interviewed to assess reasons for non-participation. RESULTS CR participation improved from 21% (14%-30%) to 63% (53%-71%) with the addition of the smartphone enabled app. Approximately 25% of the group declining the app-based program identified technology issues as the reason for non-participation. The remainder declined both CR programs or were ineligible due to frailty or comorbidities. CONCLUSIONS Use of an app-based program substantially improved CR participation. Technology and psychological barriers can limit CR participation. Innovation in CR delivery systems is required to improve uptake. CLINICALTRIAL Not applicable