Digital Health Use and Interest in Virtual Cardiac Rehabilitation Among Cardiac Inpatients: Cross-Sectional Study.

Abstract

Background: Cardiac rehabilitation (CR) improves patient quality of life, morbidity, and mortality. Unfortunately, it is underused by patients. Digital health interventions offer a solution to increase participation in CR. However, patients' interest in virtual CR, especially among those in the inpatient setting, has not been fully explored. The benefits of CR have been predominantly demonstrated in traditional, center-based CR programs.

Objective: The objective of this cross-sectional study with prospective enrollment was to explore inpatient interest in virtual CR among adult patients who were hospitalized with a CR-qualifying diagnosis.

Methods: A Qualtrics survey comprising multiple-choice questions was administered to cardiac inpatients at the progressive cardiac care unit at the Johns Hopkins Hospital from January 2020 to March 2024. Sociodemographic and clinical characteristics were retrieved from the electronic medical records. The study included English-speaking patients aged 18 years or older with a diagnosis eligible for CR. Digital health use was compared between an earlier enrollment period (2020-2022) and a later enrollment period (2023-2024).

Results: A total of 150 patients were included (mean age 64, SD 13 years; n=57, 38% female, and n=85, 56.7% White). With respect to sociodemographic characteristics, 26% (n=39) of the patients had a high school education or less, 53.8% (70/130) were married, 26.2% (34/130) were employed full time, and 63.8% (83/130) had private insurance. In exploratory enrollment-period comparisons, texting health care providers was more commonly reported in 2023 to 2024 than in 2020 to 2022 (74/123, 60.2% vs 6/27, 22.2%; P<.001), as was using a smartphone or tablet to learn about illnesses (93/123, 75.6% vs 17/27, 63%; P=.04) and to discuss health with a physician or nurse practitioner (86/123, 69.9% vs 12/27, 44.4%; P=.01). Participants with more than a high school education were more likely to perceive smartphones as beneficial for leading a healthier lifestyle (50/104, 48.1% vs 9/37, 24.3%, P=.01) and learning about illnesses (90/105, 85.7% vs 20/37, 54.1%, P<.001) than were participants with a high school education or less. Participants across all sociodemographic factors expressed interest in virtual CR (overall 107/150, 71.3%), with non-White participants being more interested than White participants (55/65, 84.6% vs 52/85, 61.2%, P=.002).

Conclusions: Most cardiac inpatients expressed interest in home-based or virtual CR to alleviate barriers to in-person CR participation. Future work should emphasize digital equity and user support to optimize the widespread adoption of virtual CR.