impact of a digital solution (cardicare™) on cardiorespiratory fitness improvement in patients discharged from a phase 2 cardiac rehabilitation following an acute coronary syndrome

Conditions: Acute Coronary Syndrome

Summary: coronary heart disease is a partial inability of the coronary arteries to supply the heart muscle due to their narrowing. there is angina and myocardial infarction. coronary heart disease is the first cause of non-communicated deaths and years of life lost. after hospital discharge, a few days following the acute care of a coronary heart disease, a formal cardiac rehabilitation programme (cr) is usually provided. cr is a comprehensive programme involving exercise training, risk factor modification, education and psychological support. it is generally sequenced in 4 phases. phase 1 begins at the hospital and consists of early mobilisation and education. most phase 2 cr models are based upon supervised ambulatory outpatient programmes. maintenance (phase 3 and 4) follows the ambulatory programme in which physical fitness and risk factor control are supported in a minimally supervised setting. despite high-grade recommendations and abundant clinical evidence, a cr program is not always implemented and the patients are not systematically referred after discharge from a phase 1 cr. furthermore, compliance to pharmacological treatments and changes in lifestyle and diet are hugely neglected following a phase 2 cr and an important number of patients resume a sedentary lifestyle. a growing body of evidence supports the use of digital tools such as smartphones and tablets in helping the patients achieve their goals in terms of physical exercise, risk-factor reduction and diet improvement. ad scientiam has developed cardicare™, a mobile application intended to provide a personalised physical training plan contributing to stabilise or improve cardiorespiratory fitness through improvement of vo2max. the mobile application cardicare™ is to be used by patients after an acute coronary syndrome, graduated from a phase 2 cardiac rehabilitation program in a cardiac rehabilitation centre and entering in phase 3 cr. the mobile application cardicare™ consists of several modules: * a physical activity recommendation engine, providing personalised weekly activity schedule, self-adapting to the patient's clinical characteristics, physical capacity and sport preferences through a proprietary algorithm * self-administered questionnaires to assess perceived exertion, chest pain, weight variations, patient's quality of life * passive monitoring of the patient's physical activity through apple's healthkit and google's fit * informational content about cardiovascular diseases, risk factor reduction and chest pain action plan the investigator's work hypothesis is that, compared to standard care, cardicare™ will stabilise or improve the cardiorespiratory fitness (vo2max) acquired post-cr.


Eligibility criteria:
inclusion criteria: * subjects ≥ 18 years old. * diagnosis of an acute coronary syndrome in the last 3 months, documented by angiographically-proven coronary artery disease or hospitalisation report. * graduated from a phase 2 cardiac rehabilitation, ready to enter a phase 3 cr at home. * having agreed to perform a cardiopulmonary exercise testing and blood count at the inclusion or having performed a cardiopulmonary exercise testing and blood count within the last week. * owning a personal smartphone (android 5.0 or beyond / iphone 5s and newer supporting ios 12 and beyond) with wifi or a data plan (3g/4g). * able to use a smartphone (e.g. no vision, hearing, cognitive or dexterity impairment). * having agreed to install cardicare™ application on their own smartphone. * having agreed to wear an actigraph at all times and install the actigraph application (centerpoint sync) on their smartphone. * enrolled in or benefiting of a national health system. * having read the information sheet and signed the informed consent form. non-inclusion criteria: * treated with coronary artery bypass grafting. * cardiac surgery in the last 12 weeks. * planned revascularisation or surgery in the next 6 months. * clinical heart failure or left ventricular ejection fraction \< 40% documented within the last 2 months. * severe valvular disease. * severe pulmonary disease. * chronic kidney disease (stages iii-v). * drug or/and alcohol abuse (as per clinician's judgment). * unstable angina. * osteoarticular condition or other reasons that limit exercise for more than 4 months (clinician's judgment). * uncontrolled hypertension (resting diastolic bp\>100 mmhg and resting systolic bp \>200 mmhg). * severe/uncontrolled arrhythmia. * systemic medical diseases that are likely to affect cognitive functioning. * pregnant women confirmed by a pregnancy test at the inclusion. * participation to another interventional clinical trial (category 1). * illiterate or not proficient in the language of the study country (french, italian, spanish or portuguese according to the country). * person under guardianship or curatorship.

Keywords: cardicare coronary heart disease application mobile acute coronary syndrome