Feasibility and effectiveness of an integrative cardiac rehabilitation employing smartphone technology (I-CREST): a pilot randomized controlled trial
Hadassah Joann Ramachandran, Tee Joo Yeo, Alvin Chuen Wei Seah, Tin Mei Yeo, Matthew Chin Heng Chua, Qamaruzaman Syed Gani, Peiying Serene Lim, Shuet Ming Lai, Jun Yi Claire Teo, Wenru Wang
Abstract
AIMS: To evaluate the feasibility and effectiveness of an integrated-cardiac rehabilitation programme employing smartphone technology (I-CREST) for patients post-acute myocardial infarction (AMI) compared with a centre-based cardiac rehabilitation (CBCR) programme. METHODS AND RESULTS: A two-arm parallel pilot randomized controlled trial was conducted with 50 post-AMI patients recruited from a tertiary hospital in Singapore. Participants were randomly allocated to either the I-CREST or the CBCR group. Data were collected at four time points: baseline, post-intervention (6 weeks), at 3 and 6 months. An intention-to-treat approach was adopted for data analysis. Out of 2825 patients screened over 20 months, 171 (6.05%) were eligible, and 50 patients were enrolled. Pre-specified success criteria for feasibility were achieved regarding engagement, with a high rate of participation in weekly telephone calls (95.8%), and intervention safety was confirmed. However, the pre-specified success criteria for feasibility related to recruitment and engagement with weekly educational content were not met. In terms of effectiveness, I-CREST demonstrated significantly higher completion rates (84 vs. 40%; P = 0.001) and better 6-minute walk test results at the 6-week time point (530.8 vs. 480.2 m; P = 0.017) compared with CBCR. CONCLUSION: This pilot study demonstrated the feasibility of the I-CREST programme, although recruitment methods require refinement. I-CREST showed promise as an effective alternative to CBCR, with fewer resources required. A full-scale study is recommended to confirm these findings statistically. REGISTRATION: ClinicalTrials.gov: NCT05270993.