Health communication in a digital world- a case study for cardiac rehabilitation

In this post I will summarize findings from a pilot study* that aims to use a phone application to increase patient participation in Cardiac Rehabilitation (CR).  The researchers measured the app’s feasibility, efficiency and integration into standard care. This study is an imperative voice in the discussion about implementing modern technology to improve healthcare efficiency and communication between the patient and the provider. This is the reason I chose to include this article in my health communication blog series, as I feel this is a great example of how technology can improve communication throughout the healthcare system.

What is Cardiac Rehabilitation (CR)?

Currently, coronary heart disease (CHD) is the most common type of heart disease, killing at the rate of 630,000 every year. Luckily, there are prevention programs, called Cardiac Rehabilitation, which “stabilize a cardiac heart disease patient after… a severe cardiac event”. These programs involve exercise, education, lifestyle modification and stress reduction. The aim is to lower rates of mortality and hospitalizations.  CR has become so beneficial for those with CHD that the program has been extended to valvular heart disease and heart transplants.

Challenges with Cardiac Rehabilitation

While benefits of Cardiac Rehabilitation (CR) are plain to see, this study, published in the Journal of Cardiopulmonary Rehabilitation and Prevention, argues that currently there are not enough CHD individuals enrolling in CR. This study claims the under enrollment is due to logistical challenges caused by the “traditional CR model”. These logistical challenges are confronted  by both the CR patients and their health care providers. For CR patients, one must consider travel logistics, balancing other responsibilities, and expensive copayments. All of these factors make it difficult for CHD patients to fit CR into their lives. The traditional CR model is also difficult to “afford and maintain” for healthcare providers. Hospital systems struggle to maintain the size, staff and equipment of the CR programs because administrators view the programs as a waste of funding. So, in summary, while patients struggle to access CR programs, the staff are urging hospitals to see the need for such programs.


Screenshot of the Health Coach mobile app

This study proposes that a solution to under-enrollment of patients in  CR is to utilize a phone application called Heart Coach (HC). The authors studied the feasibility and utility of HC.  They hypothesized that if HC is acceptable for patients and providers, it could become an effective and contemporary form of CR.

The 30 day observational pilot study included 3 staff members and 26 patients, where the patients completed tasks delivered through the HC phone app.  The HC phone app included a library of reference educational content, daily messages, and a task list that would be updated with new tasks every day. These tasks and messages included educational material sent via text, medication reminders, physical activity reminders, messages of guidance from CR staff and surveys to assess behaviors and status of patients.

This study not only observed the patients’ experience but inquired about the quality of the HC from perspective of the healthcare providers. In addition to the phone app, healthcare providers were given access to a “Web-based dashboard”, where they could monitor a patient’s daily progress, change the details of the programs in response to a patient’s needs, and send a message of guidance to patients.

Data collection and the results

Using both patient and staff engagement, the researchers gathered quantitative and qualitative data. Patient-related data was collected in the HC app and structured in specific categories which included:

  1. Patient acceptance of the application
  2. Patient engagement and task completion, and
  3. Patient feedback on their experience with the app.

The results showed an overall high percentage of patient engagement and task completion. Within the 30 day study period, patients completed at least one task 90% of the days, and finished 78% of the total assigned tasks. For the patient qualitative feedback, participants also rated their experience with the application in a positive light. On average 93 % stated that the HC app made it easier to stick to the CR program and improved the quality of their CR visits.  In contrast, staff-related data was more qualitative and involved surveys which inquired about staff engagement and patient retention. Specifically, the surveys asked staff whether patients participated in CR. The staff were also asked whether they saw HC as an acceptable part of CR. Overall, the staff claimed that HC had a positive impact on patient care, improved communication between treatment visits, and increased patient participation.


It’s apparent from the results of the study that The Heart Coach application was well accepted by patients and staff. HC also has the potential to increase communication between patients and providers and improve patient participation in the CR program. Demonstrating the feasibility and efficacy of HC provides a glimpse into the future of healthcare, where technology plays an important role. As we saw with HC, utilizing this type of contemporary tool can provide patients with more flexible and effective care, and allow providers to connect and communicate with patients more readily.

*Forman, Daniel E., et al. “Utility and efficacy of a smartphone application to enhance the learning and behavior goals of traditional cardiac rehabilitation: a feasibility study.” Journal of cardiopulmonary rehabilitation and prevention 34.5 (2014): 327-334. 

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