Edinburgh Napier University

  Background
Secondary prevention reduces coronary heart disease (CHD) progression. Traditional prevention programs including cardiac rehabilitation are under-accessed, which smartphone apps may overcome.

Aim
To evaluate the effect of a game-based mobile app intervention (MyHeartMate) to improve cardiovascular risk factors and lifestyle behaviours.

Methods
Single-blind randomised trial of CHD patients in Sydney, 2017-2021. Intervention group were provided the MyHeartMate app for 6-months. Co-designed features included an avatar of the patient’s heart and tokens earned by risk factor work (tracking, challenges, quizzes). The control group received usual care. Primary outcome was self-reported physical activity (Metabolic Equivalents [METs] Global Physical Activity Questionnaire) and secondary outcomes included lipid levels, blood pressure (BP), body mass index and smoking.

Results
Pre-specified sample size was achieved (n=390), age 61.2±11.5years; 82.5% men and 9.2% current smokers. At 6-months, adjusted for baseline levels, the intervention group achieved more physical activity than control (median difference 329 MET mins/wk), which was not statistically significant (95% CI -37.4, 696; p=.064). No differences occurred between groups on secondary outcomes except for lower triglyceride levels (mean difference -0.3 (95% CI -0.5, -0.1 mmol/L, p=.004). Acceptability was high: 94.8% of intervention participants engaged by tracking exercise or blood pressure and completing missions; 26.8% continued to engage for ≥30 days. Participants (n=14) reported the app supported tracking behaviours and risk factors, reinforcing and improving self-care confidence and decreasing anxiety.

Conclusions
A game-based app proved highly acceptable for patients with CHD but did not improve risk factors or lifestyle behaviours other than triglyceride levels.