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Completed

NCT Number: NCT03260582

Implementation and Assessment of a Life-style Focused Patient Support Application in Myocardial Infarction Patients

The study will assess the efficacy of a web-based application as a complement to traditional exercise-based cardiac rehabilitation for improvement of secondary prevention outcomes in post-myocardial infarction patients, compared with usual care. The hypothesis is that the intervention enhances patient adherence to lifestyle advice (exercise training, daily physical activity, healthy diet and tobacco abstinence) and medication, resulting in better risk factor control and prognosis as well as increased self-rated health.

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Key information

Age range

18 year–74 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Dept of Cardiology, Skane University Hospital, Lund, Sweden

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About this study

It is well documented that participation in cardiac rehabilitation (CR) programs improves risk factor control and therapy adherence, enhances quality of life and reduces recurrent events. However, the current incomplete fulfilment of guideline recommended CR targets is a matter of concern. Also, while international recommendations advocate program flexibility and individual tailoring, most of the current CR programs are rigid, time-limited and demand substantial health care resources. Therefore, all main international heart associations have claimed for the reengineering of CR to enhance access, adherence, and effectiveness. The general call is for the development of innovative and cost-effective CR programs oriented to modify lifestyle and behaviour with sustainable results and that may be easily integrated in the pre-existing health care structures.eHealth i.e. the use of electronic communication and information technologies in health care, offers a whole new array of possibilities to provide clinical care. These include for example distance monitoring via telecommunication and sensors, interactive computer programs and smart phone applications. While there are thousands of available eHealth applications on the market, only a small minority have been tested in a controlled manner with proper guidance from health care personnel. The study will assess the efficacy of a web-based patient support application as a complement to traditional exercise-based CR for improvement of secondary prevention outcomes in post-MI patients, compared with usual care. The hypothesis is that the intervention enhances patient adherence to lifestyle advice (exercise training, daily physical activity, healthy diet and tobacco abstinence) and medication, resulting in better risk factor control and prognosis as well as increased self-rated health. A secondary hypothesis is that complementing the application with an activity tracker (accelerometer in a smart bracelet) will enhance the effect of the intervention.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Age < 75 years. This cut-off is set as only those < 75 years of age are followed in the national Secondary Prevention after Heart Intensive Care Admission (SEPHIA) registry
  • Has suffered an MI within the last 2 weeks
  • Owns a smartphone and/or has access to internet via a computer or surf pad and can handle the software

Exclusion criteria

  • Expected survival < 1 year
  • Dementia, severe psychiatric illness or drug abuse
  • Severe physical handicap limiting the patient´s ability to participate in exercise-based CR
  • Not able to speak or understand the Swedish language
  • Three-vessel disease requiring coronary artery bypass grafting

Treatment and study plan

LifePod®

Other

The software is a web-based application designed to support persons adhering to lifestyle advice and medication. The patient can log information about lifestyle (i.e. diet, exercise, and smoking), measurements (i.e. weight, pulse and blood pressure), symptoms and medication and can review data in graphs displaying registered values in relation to recommended targets. The software provides positive feedback on healthy choices and gives general recommendations on exercise training, physical activity and healthy diet. Reminders are generated in the case of decreasing registrations. Finally, short text messages (SMS) will be sent out 2-3 times a week with tips on healthy lifestyle.

Primary outcomes

  1. Change in submaximal exercise capacity in watts (W)

    Time frame: Change between first (2-4 weeks post-MI) and second (4-6 months post-MI) submaximal exercise test conducted at physiotherapist visits

    Submaximal exercise capacity reflects the patients´ level of physical fitness.The submaximal exercise test is performed on a bicycle ergometer according to the World Health Organisation (WHO) protocol, with an increased workload of 25W every 4.5 minutes The initial starting load, 25W or 50W, is decided, based on the patient's exertion history. After two and four minutes of each workload; heart rate, rate of perceived exertion according to Borg's rating of perceived exertion scale (RPE) and subjective symptoms, including chest pain and dyspnea according to Borg's Category Ratio Scale, CR-10, scale are rated. After three minutes, the systolic blood pressure is registered. The exercise test is discontinued at Borg RPE 17 and/or dyspnea 7 on Borg's CR-10 scale.

Secondary outcomes

  1. Change in self-reported health

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Self-reported Health is measured using the Visual Analogue Scale (0-100)

  2. Change in healthy diet index

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    The healthy diet index is a four-item questionnaire used to evaluate dietary habits within the Swedish Secondary Prevention after Heart Intensive Care Admission (SEPHIA) registry

  3. Smoking habits

    Time frame: First (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Whether the patient is a non-smoker, prior smoker or current smoker (self-report)

  4. Change in weight

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Weight measured in kg

  5. Change in BMI

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Weight in kilograms (kg) divided by height in meters (m) square

  6. Change in waist circumference

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Waist circumference measured in cm

  7. Change in systolic blood pressure

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Systolic blood pressure measured after 5 minutes of rest in supine position (mmHg)

  8. Change in diastolic blood pressure

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Diastolic blood pressure measured after 5 minutes of rest in supine position (mmHg)

  9. Change in total cholesterol

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Fasting plasma total cholesterol

  10. Change in LDL cholesterol

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Fasting plasma LDL cholesterol (mmol/L)

  11. Change in HDL cholesterol

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Fasting plasma HDL cholesterol (mmol/L)

  12. Change in triglycerides

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Fasting plasma triglycerides (mmol/L)

  13. Change in fasting plasma glucose

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Fasting plasma glucose (mg/dL)

  14. Change in hemoglobin A1c

    Time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI

    Whole-blood hemoglobin A1c (mmol/mol) by International Federation of Clinical Chemistry (IFCC) standards

  15. Changes in self-reported physical activity

    Time frame: Change between baseline, first (2-4 weeks post-MI) and second (4-6 months post-MI) physiotherapist visits post-MI

    Self-reported physical activity, as measured by Haskell and Frändin & Grimby

  16. Uptake

    Time frame: Six months

    The proportion of patients who log on to the patient interface at least once

  17. Adherence

    Time frame: Six months

    The proportion of patients registering data at least twice per week on a weekly basis throughout the intervention period

  18. Number of contacts with the CR staff

    Time frame: 12-14 months

    Number of telephone and physical contacts with the CR staff during the follow-up period

  19. Incident cardiovascular events at one year

    Time frame: One year

    Incidence of cardiovascular events at one year after the index event: hospitalization for a new MI, heart failure or stroke and cardiovascular death

  20. Incident cardiovascular events at three years

    Time frame: Three years

    Incidence of cardiovascular events at three years after the index event: hospitalization for a new MI, heart failure or stroke and cardiovascular death

Sponsors and collaborators

Lead sponsor

Lund University

Other

Registry information

Official study title

Implementation and Assessment of a Life-style Focused Patient Support Application (App) and Activity Trackers for Improving Risk Factor Management, Physical Activity, Quality of Life and Prognosis in Post-myocardial Infarction Patients

Important dates

Study start
2016
Primary completion
2019
Study completion
2019
First posted
Aug 24, 2017
Registry last updated
Oct 25, 2019

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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