A study published recently in the JAMA Network highlights the growing concern over ischemic heart disease. Although participation in traditional ambulatory CR among older adults with ischemic heart disease is low, participation in supervised community walking is similarly low and insufficient to meet the physical activity component of acute rehabilitation.
Physical limitations, sensory impairments, lack of transportation, and cost are also barriers to CR use even in the older adult population. Despite having the greatest potential to benefit from CR due to their higher risk of adverse disease-related sequelae, older adults are least likely to participate.Â
Rehabilitation delivered at home via portable electronic devices (mobile health CR or mHealth-CR) has proliferated rapidly. The program has been tested within the older adult population and has the potential to overcome some of the barriers to participation, as mHealth-dependent CR programs differ but typically include components such as exercise tracking, remote hemodynamic assessment, video education, and electronic communication with an exercise therapist.Â
The Rehabilitation at Home Using Mobile Health in Older Adults After Hospitalization for Ischemic Heart Disease (RESILIENT) trial was carried out at five academic hospitals within 4 health systems: New York, NY (NYU Langone Health–Main Campus); Mineola, NY (NYU Langone Health–Long Island); New York, NY (Bellevue Hospital); Worcester, MA (University of Massachusetts); New Haven, CT (Yale New Haven Health). The trial enrolled from January 9, 2020, to January 10, 2024, with the last study visit on April 22, 2024.
NYU Langone Health led both study administration and data management. The trial was prospective, multicentric, nonblinded, randomized clinical trial (primary endpoint blinded). The overall objective of the RESILIENT trial was to investigate if mHealth-CR, compared to usual care, would improve functional capacity, measured as a 6-minute walk distance (6MWD), in seniors aged 65 years or older with ischemic heart disease.
Participants were screened daily from the hospital records for participants, stratified by the index condition of AMI, elective PCI, or CABG using the electronic health record. After obtaining informed consent, participants performed a 6 Minute Walk Test (6MWT) to measure baseline 6MWD. Those who completed the 6MWT were then randomly allocated in a 3:1 ratio Intervention (mHealth-CR) v control (2 ways): randomization using permuted block randomization with variable block sizes of 4 or 8. Patients aged 65 years or older hospitalized for an ischemic heart disease event operationalized as hospitalization for AMI or revascularization (PCI or CABG), who resided in rural areas.
Of 2,743 eligible patients, 1981 (72.2%) declined informed consent to participate. Total number of patients enrolled was 400 (median age, 71.0 years [range, 65.0 to 91.0 years]; 105 [26.2%] ≥75 years); 291 (72.8%) were men and 109 (27.2%) were women; between January 9, 2020, and January 10, 2024. Of these, 254 (63.5%) enrolled with the entry criterion of elective PCI. There was a total of 303 (75.8%) from White, 36 (9.0%) from Black, 17 (4.2%) from Asian, 44 (11.0%) from multiracial or another race, 34 (8.5%) Hispanic, 366 (91.5%) non-Hispanic. Nearly all (370 [92.5%]) had 2 or more chronic medical conditions; 261 (65.2%) had either frailty or prefrailty, the principal conclusion of functional capacity, compared with usual care, mHealth-CR did not result in further development in 6MWD at 3 months.Â
The mean proportion of residual angina (SAQ-7 < 100; imputed data) in patients with residual angina during the three months following either procedure was 25.7 (SD: 0.8) compared to 20.9 (SD: 1.7), with an odds ratio (OR) of 1.32 (95% CI: 0.72–2.39). At 3 months the proportion with impairment on the ADL or IADL scale was similar in the mHealth-CR and usual care groups. In the randomized clinical trial comparing mHealth-CR with usual care, mHealth-CR did not significantly increase the 6MWD, or improve due to other secondary outcomes 25.7% [0.8%] vs 20.9% [1.7%]; odds ratio (OR) 1.32; 95% CI, 0.72-2.39). There was no difference in proportion with ADL or IADL impairment at 3 months between the mHealth-CR and usual care groups.
Finally, in this randomized clinical trial, mHealth-CR did not demonstrate signs of improvement in 6 MWD or secondary outcomes compared to usual care. Results suggest that other age-tailored mHealth strategies could further improve outcomes in the older adult population.
Reference: Dodson JA, Adhikari S, Schoenthaler A, et al. Rehabilitation at Home Using Mobile Health for Older Adults Hospitalized for Ischemic Heart Disease: The RESILIENT Randomized Clinical Trial. JAMA Netw Open. 2025;8(1):e2453499. doi:10.1001/jamanetworkopen.2024.5349
