# Long-term lifestyle monitoring adherence in patients after cardiac intervention: a prospective observational trial

## TL;DR

This study examined how well patients with heart disease stick to a digital lifestyle monitoring system for a year after a cardiac procedure.

## Contribution

The study provides insights into long-term adherence and dropout rates in eHealth lifestyle monitoring systems after cardiac interventions.

## Key findings

- Most dropouts occurred in the first three months, with participation burden being the main reason.
- Health watch adherence was significantly higher than chatbot adherence.
- Lower chatbot use was linked to poorer mental well-being, while lower health watch use was linked to depressive symptoms.

## Abstract

Lifestyle behaviours are important predictors of morbidity and mortality in patients with cardiovascular disease. However, structured lifestyle monitoring is insufficiently integrated into clinical practice. This study evaluated dropout and long-term adherence to an eHealth system for self-monitoring lifestyle behaviours in patients with cardiovascular disease.

Patients undergoing a cardiac intervention used an eHealth system (web application with integrated health watch and chatbot) to monitor physical activity, nutrition, stress, and sleep for 1 year. The primary outcome was dropout, defined as system disengagement. Secondary outcomes included adherence (percentage of prescribed health watch wear time and chatbot responses) and usability. The predictive value of demographic, clinical, and psychosocial factors was examined using logistic regression models. Of 100 patients (mean age 61.6 ± 10.4 years; 88% male; 45% percutaneous coronary intervention, 55% other intervention), there were 43 dropouts; most (27; 63%) occurred in the first quarter, with participation burden being the most cited reason (51%). Health watch adherence was higher than chatbot adherence (80.7% (66.6–90.3%) vs. 60.8% (30.7–82.7%), P < 0.001). Low chatbot adherence was associated with poorer mental well-being, while lower health watch adherence was associated with higher levels of depressive symptoms. System usability was rated acceptably usable (62.2 ± 14.7).

Long-term lifestyle monitoring of multiple health-related behaviours is feasible after cardiac intervention, highlighting its potential for integration into clinical practice. Patient engagement could be enhanced by targeting subgroups at risk of low adherence, particularly in the early phase, and by reducing self-reporting burden while improving usability.

Graphical AbstractHADS, Hospital Anxiety and Depression Scale; mEMA, mobile Ecological Momentary Assessment; PCI, Percutaneous Coronary Intervention; QoL, Quality of Life; SUS, System Usability Scale. Values are presented as mean (± SD) for normally distributed variables and as median (IQR) for non-normally distributed variables.

HADS, Hospital Anxiety and Depression Scale; mEMA, mobile Ecological Momentary Assessment; PCI, Percutaneous Coronary Intervention; QoL, Quality of Life; SUS, System Usability Scale. Values are presented as mean (± SD) for normally distributed variables and as median (IQR) for non-normally distributed variables.