Evaluation of the management effect of

doi:10.3969/j.issn.1674-8115.2022.03.003

Abstract

Abstract: Objective

·To explore the application effect of the wearable electrocardiogram (ECG) device based on “Internet+” on chronic disease management of patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).

Methods

·Patients with CHD hospitalized in the Heart Center of the First Affiliated Hospital of Xinjiang Medical University from April 2021 to September 2021 and treated with PCI were randomly divided into control group and intervention group, with 60 cases in each group. All patients in the control group were treated with the management mode of health education and routine follow-up before discharge, while those in the intervention group were treated with additional ECG monitoring daily and during exercise by using the remotely wearable ECG device in the “Internet+” chronic disease management mode managed and promoted on social media platform. The changes of the resting heart rate (RHR) and its compliance rate, the scores of Perceived Knowledge Scale for CHD (PKS-CHD) and the scores of Coronary Artery Disease Self-Management Scale (CSMS) in the two groups after intervention as well as the detection rates of arrhythmia and ST segment changes in electrocardiogram were observed.

Results

·Before intervention, there was no significant difference in RHR and PKS-CHD scores between the two groups. After intervention, there were significant differences in RHR compliance rate, RHR, the total score of PKS-CHD, the scores of five dimensions (risk factors, inducing factors, clinical manifestations, drug knowledge and secondary prevention) of PKS-CHD, the total score of CSMS and the scores of five dimensions (bad habits management, general life management, symptom management, disease knowledge management, and compliance management) of CSMS between the two groups (all P<0.05). The detection rate of arrhythmia (44.8%) and ST segment changes (22.4%) in the intervention group were higher than those in the control group (26.8% and 8.9%, respectively), and the differences were statistically significant (both P<0.05).

Conclusion

·The application of the wearable ECG device based on “Internet+” in chronic disease management of CHD patients after PCI can improve the compliance rate by decreasing RHR, the self-management behavior and knowledge level, as well as the detection rate of arrhythmia and ST segment changes.

Key words: Internet+, wearable electrocardiogram device, chronic disease management, coronary heart disease (CHD)

CLC Number:

R473.5

LIANG Cunyu, ZHAO Qian, SONG Ning, MEN Li, CHEN Qingjie, CHU Junkun, PU Jun, LI Xiaomei, YANG Yining. Evaluation of the management effect of "Internet+"-based wearable ECG devices in coronary heart disease patients undergoing PCI[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(3): 275-281.

Figures/Tables 6

TrendMD

References 25

1	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2019概要[J]. 中国循环杂志, 2020, 35(9): 833-854.
2	ARMSTRONG P W, GERSHLICK A H, GOLDSTEIN P, et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction[J]. N Engl J Med, 2013, 368(15): 1379-1387.
3	赵明中, 郝晓慧. 冠心病介入术后康复管理[J]. 中西医结合心血管病电子杂志, 2016, 4(18): 1-3, 6.
4	WOODRUFFE S, NEUBECK L, CLARK R A, et al. Australian Cardiovascular Health and Rehabilitation Association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014[J]. Heart Lung Circ, 2015, 24(5): 430-441.
5	JELINEK M V, THOMPSON D R, SKI C, et al. 40 years of cardiac rehabilitation and secondary prevention in post-cardiac ischaemic patients. Are we still in the wilderness? [J]. Int J Cardiol, 2015, 179: 153-159.
6	ZHANG L X, ZHANG L, WANG J, et al. Community health service center-based cardiac rehabilitation in patients with coronary heart disease: a prospective study[J]. BMC Health Serv Res, 2017, 17(1): 128.
7	RAWSTORN J C, GANT N, DIREITO A, et al. Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis[J]. Heart, 2016, 102(15): 1183-1192.
8	BOUKHRIS M, HILLANI A, MORONI F, et al. Cardiovascular implications of the COVID-19 pandemic: a global perspective[J]. Can J Cardiol, 2020, 36(7): 1068-1080.
9	PFAEFFLI DALE L, WHITTAKER R, JIANG Y N, et al. Text message and Internet support for coronary heart disease self-management: results from the Text4Heart randomized controlled trial[J]. J Med Internet Res, 2015, 17(10): e237.
10	RIBEIRO F, ALVES A J, TEIXEIRA M, et al. Exercise training enhances autonomic function after acute myocardial infarction: a randomized controlled study[J]. Portuguese J Cardiol Off J Portuguese Soc Cardiol, 2012, 31(2): 135-141.
11	陈韬, 刘阁, 韩宝石, 等. 基于“互联网+”的可穿戴式心电图应用分析[J]. 中华保健医学杂志, 2020, 22(1): 16-18.
12	肖美莲. 住院冠心病患者个体化健康教育效果评价[D]. 长沙: 中南大学, 2007.
13	任洪艳. 冠心病自我管理量表开发及健康教育研究[D]. 重庆: 重庆医科大学, 2009.
14	MEMBERS T F, MONTALESCOT G, SECHTEM U, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology[J]. Eur Heart J, 2013, 34(38): 2949-3003.
15	FLETCHER G F, BALADY G J, AMSTERDAM E A, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association[J]. Circulation, 2001, 104(14): 1694-1740.
16	BRIFFA T G, HOBBS M S, TONKIN A, et al. Population trends of recurrent coronary heart disease event rates remain high[J]. Circ Cardiovasc Qual Outcomes, 2011, 4(1): 107-113.
17	袁雨涵, 高春红, 汤一帆, 等. 冠心病管理APP对老年冠心病病人PCI术后自我管理与生活质量的效果[J]. 实用老年医学, 2022, 36(1): 100-103.
18	曹欢, 熊琦. 基于互联网技术的健康管理平台模式在心血管病出院患者中的应用效果[J]. 中国当代医药, 2021, 28(34): 46-49.
19	FIHN S D, GARDIN J M, ABRAMS J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons[J]. J Am Coll Cardiol, 2012, 60(24): e44-e164.
20	ZHANG D F, SHEN X L, QI X. Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis[J]. CMAJ, 2016, 188(3): E53-E63.
21	EITEL I, DESCH S, FUERNAU G, et al. Prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction[J]. J Am Coll Cardiol, 2010, 55(22): 2470-2479.
22	HUANG G Y, SHI X R, DAVIS-BREZETTE J A, et al. Resting heart rate changes after endurance training in older adults: a meta-analysis[J]. Med Sci Sports Exerc, 2005, 37(8): 1381-1386.
23	REIMERS A K, KNAPP G, REIMERS C D. Effects of exercise on the resting heart rate: a systematic review and meta-analysis of interventional studies[J]. J Clin Med, 2018, 7(12): 503.
24	RAWSHANI N, RAWSHANI A, GELANG C, et al. Association between use of pre-hospital ECG and 30-day mortality: a large cohort study of patients experiencing chest pain[J]. Int J Cardiol, 2017, 248: 77-81.
25	ESCOBAR-CURBELO L, FRANCO-MORENO A I. Application of telemedicine for the control of patients with acute and chronic heart diseases[J]. Telemed J E Health, 2019, 25(11): 1033-1039.

Item	Control group （n=56）	Intervention group（n=58）	t/χ² value	P value
Age/year	49.79±6.29	49.22±6.05	-0.444	0.658
Gender/Male/n （%）	49 （87.5）	45 （77.6）	1.936	0.164
Ethnicity/n （%）			0.162	0.681
Han	51 （91.1）	54 （93.1）
Others	5 （8.9）	4 （6.9）
Education level/n （%）			2.720	0.437
Elementary school and below	6 （10.7）	10 （17.2）
Junior high school	25 （44.6）	29 （50.0）
High school	17 （30.4）	15 （25.9）
University and higher	8 （14.3）	4 （6.9）
Coronary lesion/n （%）			1.359	0.507
1	12 （21.4）	9 （15.5）
2	28 （50.0）	27 （46.6）
3	16 （28.6）	22 （37.9）
High blood pressure/n （%）			0.056	0.813
Yes	35 （62.5）	35 （60.3）
No	21 （37.5）	23 （39.7）
Diabetes/n（%）			2.228	0.135
Yes	26 （46.4）	19 （32.8）
No	30 （53.6）	39 （67.2）
Hyperlipidemia/n （%）			1.350	0.245
Yes	35 （62.5）	30 （51.7）
No	21 （37.5）	28 （48.3）
Smoking/n （%）			0.880	0.348
Yes	43 （76.8）	40 （69.0）
No	13 （23.2）	18 （31.0）

Item	Control group （n=56）	Intervention group（n=58）	t/χ² value	P value
Age/year	49.79±6.29	49.22±6.05	-0.444	0.658
Gender/Male/n （%）	49 （87.5）	45 （77.6）	1.936	0.164
Ethnicity/n （%）			0.162	0.681
Han	51 （91.1）	54 （93.1）
Others	5 （8.9）	4 （6.9）
Education level/n （%）			2.720	0.437
Elementary school and below	6 （10.7）	10 （17.2）
Junior high school	25 （44.6）	29 （50.0）
High school	17 （30.4）	15 （25.9）
University and higher	8 （14.3）	4 （6.9）
Coronary lesion/n （%）			1.359	0.507
1	12 （21.4）	9 （15.5）
2	28 （50.0）	27 （46.6）
3	16 （28.6）	22 （37.9）
High blood pressure/n （%）			0.056	0.813
Yes	35 （62.5）	35 （60.3）
No	21 （37.5）	23 （39.7）
Diabetes/n（%）			2.228	0.135
Yes	26 （46.4）	19 （32.8）
No	30 （53.6）	39 （67.2）
Hyperlipidemia/n （%）			1.350	0.245
Yes	35 （62.5）	30 （51.7）
No	21 （37.5）	28 （48.3）
Smoking/n （%）			0.880	0.348
Yes	43 （76.8）	40 （69.0）
No	13 （23.2）	18 （31.0）

Item	Control group （n=56）	Intervention group （n=58）	t value	Ρ value
Total score/score	26.60±2.06	26.33±2.54	-0.631	0.529
Concept/score	1.85±0.77	1.92±0.74	0.480	0.632
Risk factor/score	3.13±0.74	3.00±0.68	-1.016	0.312
Predisposing factor/score	2.61±0.69	2.63±0.71	-1.300	0.897
Clinical presentation/score	2.75±0.60	2.66±0.63	-0.743	0.459
Inspection method/score	2.43±0.75	2.71±0.78	-0.821	0.413
Treatment method/score	2.75±0.93	3.78±1.08	-0.238	0.812
Drug knowledge/score	3.90±0.93	3.78±1.08	-0.635	0.527
Secondary prevention/score	7.15±1.15	7.33±1.16	-0.971	0.386

Item	Control group （n=56）	Intervention group （n=58）	t value	Ρ value
Total score/score	26.60±2.06	26.33±2.54	-0.631	0.529
Concept/score	1.85±0.77	1.92±0.74	0.480	0.632
Risk factor/score	3.13±0.74	3.00±0.68	-1.016	0.312
Predisposing factor/score	2.61±0.69	2.63±0.71	-1.300	0.897
Clinical presentation/score	2.75±0.60	2.66±0.63	-0.743	0.459
Inspection method/score	2.43±0.75	2.71±0.78	-0.821	0.413
Treatment method/score	2.75±0.93	3.78±1.08	-0.238	0.812
Drug knowledge/score	3.90±0.93	3.78±1.08	-0.635	0.527
Secondary prevention/score	7.15±1.15	7.33±1.16	-0.971	0.386

Item	Control group （n＝56）	Intervention group （n=58）	t/χ² value	P value
RHR before the intervention/beat‧min^-1	66.04±4.05	66.55±4.90	0.611	0.542
RHR after the intervention/beat‧min^-1	61.11±2.93	58.77±2.81	-4.33	0.000
RHR rangeability/beat‧min^-1	4.93±3.83	7.78±4.36	3.698	0.000
Control rate/n（%）	26 （46.4）	45 （77.6）	11.77	0.000