Interactive mHealth App Helped Improve Patients’ Lifestyle Habits After Undergoing PCI

For patients with coronary heart disease who received a percutaneous coronary intervention (PCI), using the interactive mobile health (mHealth) application EVITE helped these patients improve and adhere to lifestyle changes.

According to a study published in JMIR mHealth and uHealth, these lifestyle changes included adherence to the Mediterranean diet, improved frequency of healthy food consumption, increased physical activity, and quitting smoking.¹ The EVITE app also helped patients increase their knowledge of healthy lifestyles and the control of cardiovascular risk factors (CVRFs), and patients reported overall satisfaction with the app and improved quality of life. The app had multiple components—website, messages, emails, and calls—to encourage users to adhere to the lifestyle modifications, and associated taking medication with these daily activities to help establish set times for taking their medication.

“The self-monitoring and recording in the app improves the patients’ awareness of their lifestyle behavior, and motivation promotes the initiation and continuation of changes in behavior over time,” the authors said.

Coronary heart disease is a leading cause of death worldwide, and secondary prevention is essential to reduce the risk of further coronary events. As defined by Yale Medicine, a PCI is a non-surgical procedure that treats coronary artery blockages by opening up narrowed or blocked sections of the artery and restoring proper blood circulation to the heart.² Less invasive than a coronary artery bypass surgery, this procedure is usually conducted through a small artery in the wrist. Approximately 900,000 PCIs are performed annually in the US alone, with most patients discharged from the hospital within 24 hours and going back to their normal daily routines after a minimal recovery period.

In this randomized controlled trial, 128 participants were assigned to either the mHealth intervention group (n = 67) or the control group receiving standard health care (n = 61). Of this group, 71.9% were male and the mean (SD) age was 59.49 (8.97) years. The app facilitated goal-setting and self-monitoring of lifestyle habits and CVRFs, provided educational resources on healthy living, and offered motivational feedback on achievements and areas for improvement.

After 9 months, patients in the mHealth group demonstrated significant lifestyle improvements compared with the control group across several parameters. It is important to note that this study included patients who underwent PCI in Spain between November 2019 and June 2022, so precautions taken during the COVID-19 pandemic could potentially have impacted certain lifestyle changes during the study.

Mediterranean diet adherence was determined using the Mediterranean Adherence Score out of 14 points, with scores below 9 deemed low adherence and scores above 9 deemed high adherence. At baseline, adherence scores were similar between the mHealth (7.24) and control group (7.52). After 9 months, patients who used the mHealth app had a mean (SD) score of 11.83 (1.74) points, compared with a mean score of 10.14 (2.02) points in the control group (P < .001). Proportionally, more patients in the mHealth group adhered to the Mediterranean diet with a score above 9 points (90%) compared with the control group (75%; P = .02).

Using the food frequency questionnaire, the researchers found a significant reduction in the consumption of red meat and industrial pastries among those using the app compared with those in the control group. Meanwhile, patients using the app also significantly increased their vegetable, fruit, and whole-meal cereal consumption.

In another similar trend, the group using the EVITE app increased their physical activity significantly more than the control group, according to patient-reported entries. At baseline, the mHealth group was already slightly more active than the control group by about 35 minutes per week, but this difference increased drastically to nearly 150 minutes per week between the groups at 9 months; patients in the mHealth group increased their physical activity to a mean (SD) of 619.14 (318.21) min/week compared with 471.70 (261.43) min/week in the control group (P = .007).

At baseline, 33 mHealth patients and 26 control patients were active smokers. After 9 months, 25 patients who used the app quit smoking compared with 11 patients who did not use the app (P = .01).

A validated scale with 24 items and five response options was utilized to assess participants' understanding of CVRFs and healthy lifestyle practices, with a maximum possible score of 120 points. A high level of knowledge was defined as correctly answering over 75% of the items or scoring at least 90 points on the scale. Participants in the mHealth group exhibited notably greater understanding of healthy lifestyle practices and cardiovascular risk factor management after using the app compared with those in the control group, with a mean (SD) score of 118.70 (2.65) points in the mHealth group compared with 111.25 (9.05) points in the control group (P < .001). However, therapeutic adherence showed similar improvements in both groups by the end of the follow-up period, with no statistically significant variances observed between them.

“Knowledge of the risk factors for the disease is an essential requirement for patients to decide to adopt behaviors in line with a healthy lifestyle,” the authors said. “However, people also need to be motivated to incorporate such behavior into their daily lives. Innovative mHealth technology could help to achieve both objectives by increasing the patients’ knowledge and motivation.”

In terms of quality of life, patients in the intervention group demonstrated significantly better scores in the physical component compared with the control group, while both groups showed similar scores for the mental component. Although the mHealth group showed slightly better scores in the well-being index, the difference did not reach statistical significance. Regarding overall satisfaction with health care, patients in the mHealth group rated their experience higher than those receiving standard health care, with mean (SD) scores of 48.22 (3.89) points and 46.00 (4.82) points, respectively, out of a maximum of 50 points (P = .002).

“More studies are required to examine the impact of smartphone interventions on people who have undergone a coronary event, with long-term follow-ups that analyze mortality and cardiac-cause hospitalization, because these are important yardsticks of the success of secondary prevention strategies that make it possible to establish the clinical importance of the findings,” the authors concluded. “Cost analyses are also required to promote the generalized use of these tools, their implementation, and their feasibility.”

References

1. Bernal-Jiménez MÁ, Calle G, Gutiérrez Barrios A, et al. Effectiveness of an interactive mhealth app (EVITE) in improving lifestyle after a coronary event: randomized controlled trial. JMIR Mhealth Uhealth. 2024;12:e48756. doi:10.2196/48756
2. Percutaneous coronary intervention (PCI). Yale Medicine. Accessed April 24, 2024. https://www.yalemedicine.org/conditions/percutaneous-coronary-intervention-pci