SMARTphone-based, early cardiac REHABilitation in patients with acute coronary syndromes: A Randomized Controlled Trial Protocol [SMART-REHAB Trial]

The smartphone-based secondary prevention program will be delivered over 8 weeks starting at time of discharge from hospital through a smartphone application (app). This is a multi-faceted intervention with particular emphasis on early mobilization. The app provides a platform to deliver a comprehensive secondary prevention program. The different components of the program are: 1. Exercise Prescription - Patients will have access to real-time feedback of their activity levels through the app’s activity tracker which links to the smartphone’s accelerometer feature. Patients will be able to monitor the number of steps taken and the distance walked. Patients will undertake a graded walking program increasing in time and intensity over the 8 weeks. Patients will increase their daily steps by 1,000steps a week until they reach 10,000 steps. 2. Dynamic tracking of cardiovascular risk factors - Patients will have an interactive personal dashboard highlighting the status of their cardiovascular risk factors. Blood pressure, cholesterol levels, glucose levels, weight, smoking status will be graded depending whether they are at recommended target levels. 3. Dietary Habits - Dietary habits will be tracked through the app via access to the phone’s inbuilt camera. Patients will be encouraged to photograph the food they consume. 4. Cardiac Education - Two educational messages per week will be delivered to the participants as they progress through the 8-week SSPP. 5. Cardiac Medication List - Patients will input their discharge medications into the app prior to leaving hospital. The medication list will be reviewed to ensure that appropriate evidence-based pharmacotherapy (dual antiplatelet therapy, statin, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker) has been prescribed. 6. Interactive and Personalized Feedback -Patients will receive five personalized messages per week via the app messaging service. Two of the messages will be educational and the remaining three messages provide goal setting feedback on physical activity levels and diet. 7. Support - The messaging service also allows the patient to initiate contact if they have any questions regarding their cardiac condition or rehabilitation process. Adherence will be measure by number of times a patient logs into app.