Effectiveness of a Tele-cardiac Rehabilitation (Tele-CR) Program

The Chinese version of the Seattle Angina Questionnaire (SAQ), translated by Tsai and Chie (2002), is used to assess participants' health-related quality of life over the past month. The questionnaire consists of 19 items covering five domains. Each question is scored using an ordinal scale, and each aspect is converted into [(total score of the aspect question - minimum total score)/scoring range * 100] from 0 to 100 points, with higher scores indicating better status in that domain. In this study, the average of three domains-physical activity, angina frequency, and disease perception (each with a score range of 0-100)-is considered the overall SAQ score. A higher total score reflects better overall health-related quality of life (Patel et al., 2018). The test-retest reliability of the Chinese version of the SAQ over 3 to 4 weeks ranges from 0.44 to 0.79; internal consistency ranges from 0.43 to 0.84; and criterion-related validity ranges from 0.44 to 0.84 (Tsai and Chie, 2002).

The EuroQol-5-Dimensions-5-Level (EQ-5D-5L) is a widely used generic quality-of-life scale that has been translated into multiple languages and has demonstrated good reliability and validity (EuroQol Research Foundation, 2019; Feng et al., 2021). The five-digit health state profiles are converted into a utility value using a set of weights derived from a Taiwanese population study, ensuring suitability for the Chinese population. The utility value ranges from -1.0259 to 1, where lower values indicate poorer health-related quality of life (Lin et al., 2018). The second component of the EQ-5D-5L is a visual analog scale (VAS) ranging from 0 to 100, where higher scores reflect better self-perceived quality of life (EuroQol Research Foundation, 2019).

This study used the Chinese version of the Heart Health Self-Efficacy and Self-Management (HH-SESM) scale, translated and revised by Wu et al. (2022). The scale comprises 12 items covering domains such as physical activity, diet, medication, psychosocial factors, weight management, and smoking. Each item includes two parts: self-efficacy and self-management. The self-efficacy subscale asks, "How confident are you that you can do the following?", while the self-management subscale asks, "How often do you do the following?" Both are scored using a 4-point Likert scale. Higher total scores indicate greater levels of self-efficacy and self-management. The internal consistency of the Chinese version of the HH-SESM ranges from 0.72 to 0.77; the two-week test-retest reliability ranges from 0.71 to 0.76; the split-half reliability is between 0.79 and 0.80; and the explained variance ranges from 25.2% to 31.1% (Wu et al., 2022).

The 8-item version Morisky Medication Adherence Scale (MMAS-8) consists of 8 items. Each of the first 7 items has 2 possible responses (yes/no), while the 8th item is answered with a 5-point Likert scale. The possible total medication adherence score ranges between 0 and 8, and the higher the score, the better the adherence level. A total score < 6 isconsidered low adherence, while a total score of ≥ 6 but < 8 indicates moderate adherence, and a scoreof 8 indicates high adherence (Berlowitz et al., 2017; Bress et al., 2017). The original MMAS-8 has demonstrated good reliability and validity (Moon et al., 2017). For the Chinese version, internal consistency ranges from 0.65 to 0.83, explaining approximately 46% of the variance, with a test-retest correlation coefficient of 0.80 (Ho & Lee, 2014; Wang et al., 2013).

The original version of the Hospital Anxiety and Depression Scale (HADS) was developed by Zigmond and Snaith in 1983. The Chinese version of the HADS is used to assess anxiety and depression symptoms experienced by individuals over the past week. It consists of 14 items, with 7 items measuring anxiety and 7 items measuring depression. Each item is rated on a four-point scale (0-3), yielding subscale scores ranging from 0 to 21. Higher scores indicate more severe levels of anxiety or depression. The internal consistency of the Chinese version of the HADS ranges from 0.77 to 0.82, and the one-week test-retest reliability ranges from 0.64 to 0.83 (Chen et al., 1999).

Values will be extracted from medical records. The baseline value will be based on the closest hospitalization date within the three months before hospitalization. The post-discharge value will be based on the closest questionnaire filling date (i.e., at 3, 6, 9, and 12 months after discharge). BMI will be calculated using body weight (in kilograms) and height (in meters) according to the formula: BMI = weight (kg) / [height (m)]².

Unit of measure: Kilograms per square meter (kg/m²).

Values will be extracted from medical records. The baseline value will be based on the closest hospitalization date within the three months before hospitalization. The post-discharge value will be based on the closest questionnaire filling date (i.e., at 3, 6, 9, and 12 months after discharge).

Unit of measure: Millimeters of mercury (mmHg).

Values will be extracted from medical records. The baseline value will be based on the closest hospitalization date within the three months before hospitalization. The post-discharge value will be based on the closest questionnaire filling date (i.e., at 3, 6, 9, and 12 months after discharge).

Unit of measure: Millimeters of mercury (mmHg).

Values will be extracted from medical records. The baseline value will be based on the closest hospitalization date within the three months before hospitalization. The post-discharge value will be based on the closest questionnaire filling date (i.e., at 3, 6, 9, and 12 months after discharge).

Unit of measure: Milligrams per deciliter (mg/dL).

Values will be extracted from medical records. The baseline value will be based on the closest hospitalization date within the three months before hospitalization. The post-discharge value will be based on the closest questionnaire filling date (i.e., at 3, 6, 9, and 12 months after discharge).

Unit of measure: Percentage (%).

Values will be extracted from medical records. The baseline value will be based on the closest hospitalization date within the three months before hospitalization. The post-discharge value will be based on the closest questionnaire filling date (i.e., at 3, 6, 9, and 12 months after discharge).

Unit of measure: Milligrams per deciliter (mg/dL).

Values will be extracted from medical records. The baseline value will be based on the closest hospitalization date within the three months before hospitalization. The post-discharge value will be based on the closest questionnaire filling date (i.e., at 3, 6, 9, and 12 months after discharge).

Unit of measure: Milligrams per deciliter (mg/dL).

Values will be extracted from medical records. The baseline value will be based on the closest hospitalization date within the three months before hospitalization. The post-discharge value will be based on the closest questionnaire filling date (i.e., at 3, 6, 9, and 12 months after discharge).

Unit of measure: Milligrams per deciliter (mg/dL).

Values will be extracted from medical records. The baseline value will be based on the closest hospitalization date within the three months before hospitalization. The post-discharge value will be based on the closest questionnaire filling date (i.e., at 3, 6, 9, and 12 months after discharge).

Unit of measure: Milligrams per deciliter (mg/dL).