Digital Health Programs to Reduce Readmissions in Coronary Artery Disease: A Systematic Review and Meta-Analysis

Justin Braver; Thomas H Marwick; Brian Oldenburg; Ayuba Issaka; Melinda J Carrington

doi:10.1016/j.jacadv.2023.100591

Digital Health Programs to Reduce Readmissions in Coronary Artery Disease: A Systematic Review and Meta-Analysis

JACC Adv. 2023 Sep 7;2(8):100591. doi: 10.1016/j.jacadv.2023.100591. eCollection 2023 Oct.

Authors

Justin Braver^{1

2}, Thomas H Marwick^{1

2}, Brian Oldenburg^{3

4}, Ayuba Issaka^{3

4}, Melinda J Carrington^{1

2}

Affiliations

¹ Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia.
² Pre-Clinical Disease and Prevention Unit, Baker Heart and Diabetes Institute, Victoria, Australia.
³ Non-Communicable Diseases and Implementation Science Unit, Baker Heart and Diabetes Institute, Victoria, Australia.
⁴ School of Psychology and Public Health, La Trobe University, Melbourne, Australia.

Abstract

Background: The use of mobile health (mHealth, wireless communication devices, and/or software technologies) in health care delivery has increased rapidly in recent years. Their integration into disease management programs (DMPs) has tremendous potential to improve outcomes for patients with coronary artery disease (CAD), yet a more robust evaluation of the evidence is required.

Objectives: The purpose of this study was to undertake a systematic review and meta-analysis of mHealth-enabled DMPs to determine their effectiveness in reducing readmissions and mortality in patients with CAD.

Methods: We systematically searched English language studies from January 1, 2007, to August 3, 2021, in multiple databases. Studies comparing mHealth-enabled DMPs with standard DMPs without mHealth were included if they had a minimum 30-day follow-up for at least one of all-cause or cardiovascular-related mortality, readmissions, or major adverse cardiovascular events.

Results: Of the 3,411 references from our search, 155 full-text studies were assessed for eligibility, and data were extracted from 18 publications. Pooled findings for all-cause readmissions (10 studies, n = 1,514) and cardiac-related readmissions (9 studies, n = 1,009) indicated that mHealth-enabled DMPs reduced all-cause (RR: 0.68; 95% CI: 0.50-0.91) and cardiac-related hospitalizations (RR: 0.55; 95% CI: 0.44-0.68) and emergency department visits (RR: 0.37; 95% CI: 0.26-0.54) compared to DMPs without mHealth. There was no significant reduction for mortality outcomes (RR: 1.72; 95% CI: 0.64-4.64) or major adverse cardiovascular events (RR: 0.68; 95% CI: 0.40-1.15).

Conclusions: DMPs integrated with mHealth should be considered an effective intervention for better outcomes in patients with CAD.

Keywords: cardiac rehabilitation; coronary artery disease; digital health; disease management; health technology; mHealth.