M-Health and cardiac rehabilitation: Adherence to mobile app after a cardiac rehabilitation programme and reasons for dropping out

Abstract Introduction M-health enables the use of mobile technology for public health purposes. There are several mobile apps that aim to improve the prognosis of patients after a cardiovascular event. However, adherence to mobile apps often drops dramatically in the first weeks of follow-up showing adherence rates of about 20-40% in the first three months and 9-16% at 6 months. Purpose The aim of the study was to analyse adherence to a mobile app in patients who had completed a cardiac rehabilitation programme (phase III, maintenance phase). Secondary objectives were to analyse the main reasons why patients discontinued the mobile app. Methods A multicenter randomised clinical trial was conducted in 319 patients who had completed a cardiac rehabilitation programme. Patients were randomised to use a mobile app (n=161) or routine follow-up (n=158). Adherence to the mobile app was assessed at months 1, 3, 6, 12, 18 and 24 of follow-up. As part of the follow-up process, telephone interviews were conducted to assess the reasons for abandonment of the mobile application. Results Of the 161 patients assigned to the mobile application intervention group, 25% made no or only one connection to the application (median 11 connections 1-82, mean 65 connections +- 119). Adherence to the mobile application decreased as follow-up progressed: 1 month (67%), 3 months (52%), 6 months (35%), 12 months (17%), 18 months (8%), 24 months (6%) (Figure 1). The reason for leaving the mobile application was collected from 156 patients. Of them 19.9% did not give a clear reason for leaving the mobile application and 19.2% had never logged in or had left the application in the first week. The most common reasons for abandonment were: application breakdowns (16%), lack of time to enter data (9.6%), feeling well and seeing no need to use it (9%), change of mobile phone (8.3%) or poor relationship with technology (7.1%). The remaining reasons for lower prevalence are listed in Table 1. Conclusions Our mobile application shows higher adherence compared to other studies (52% at 3 months, 35% at 6 months), however adherence remains low. Knowing the reasons behind the abandonment of mobile applications could be a way to correct them and maintaining long-term medical contact via telemedicine in patients with cardiovascular disease.Figure 1. Table 1