Post-Stroke Cardiovascular Complications and Neurogenic Cardiac Injury: JACC State-of-the-Art Review

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Interactive MHealth App Helped Improve Patients' Lifestyle Habits After Undergoing PCI

These lifestyle improvements included adherence to the Mediterranean diet, improved frequency of healthy food consumption, increased physical activity, and quitting smoking, among other factors.

For patients with coronary heart disease who received a percutaneous coronary intervention (PCI), using the interactive mobile health (mHealth) application EVITE helped these patients improve and adhere to lifestyle changes.

Mobile health appImage credit: Kaspars Grinvalds – stock.Adobe.Com

According to a study published in JMIR mHealth and uHealth, these lifestyle changes included adherence to the Mediterranean diet, improved frequency of healthy food consumption, increased physical activity, and quitting smoking.1 The EVITE app also helped patients increase their knowledge of healthy lifestyles and the control of cardiovascular risk factors (CVRFs), and patients reported overall satisfaction with the app and improved quality of life. The app had multiple components—website, messages, emails, and calls—to encourage users to adhere to the lifestyle modifications, and associated taking medication with these daily activities to help establish set times for taking their medication.

"The self-monitoring and recording in the app improves the patients' awareness of their lifestyle behavior, and motivation promotes the initiation and continuation of changes in behavior over time," the authors said.

Coronary heart disease is a leading cause of death worldwide, and secondary prevention is essential to reduce the risk of further coronary events. As defined by Yale Medicine, a PCI is a non-surgical procedure that treats coronary artery blockages by opening up narrowed or blocked sections of the artery and restoring proper blood circulation to the heart.2 Less invasive than a coronary artery bypass surgery, this procedure is usually conducted through a small artery in the wrist. Approximately 900,000 PCIs are performed annually in the US alone, with most patients discharged from the hospital within 24 hours and going back to their normal daily routines after a minimal recovery period.

In this randomized controlled trial, 128 participants were assigned to either the mHealth intervention group (n = 67) or the control group receiving standard health care (n = 61). Of this group, 71.9% were male and the mean (SD) age was 59.49 (8.97) years. The app facilitated goal-setting and self-monitoring of lifestyle habits and CVRFs, provided educational resources on healthy living, and offered motivational feedback on achievements and areas for improvement.

After 9 months, patients in the mHealth group demonstrated significant lifestyle improvements compared with the control group across several parameters. It is important to note that this study included patients who underwent PCI in Spain between November 2019 and June 2022, so precautions taken during the COVID-19 pandemic could potentially have impacted certain lifestyle changes during the study.

Mediterranean diet adherence was determined using the Mediterranean Adherence Score out of 14 points, with scores below 9 deemed low adherence and scores above 9 deemed high adherence. At baseline, adherence scores were similar between the mHealth (7.24) and control group (7.52). After 9 months, patients who used the mHealth app had a mean (SD) score of 11.83 (1.74) points, compared with a mean score of 10.14 (2.02) points in the control group (P < .001). Proportionally, more patients in the mHealth group adhered to the Mediterranean diet with a score above 9 points (90%) compared with the control group (75%; P = .02).

Using the food frequency questionnaire, the researchers found a significant reduction in the consumption of red meat and industrial pastries among those using the app compared with those in the control group. Meanwhile, patients using the app also significantly increased their vegetable, fruit, and whole-meal cereal consumption.

In another similar trend, the group using the EVITE app increased their physical activity significantly more than the control group, according to patient-reported entries. At baseline, the mHealth group was already slightly more active than the control group by about 35 minutes per week, but this difference increased drastically to nearly 150 minutes per week between the groups at 9 months; patients in the mHealth group increased their physical activity to a mean (SD) of 619.14 (318.21) min/week compared with 471.70 (261.43) min/week in the control group (P = .007).

At baseline, 33 mHealth patients and 26 control patients were active smokers. After 9 months, 25 patients who used the app quit smoking compared with 11 patients who did not use the app (P = .01).

A validated scale with 24 items and five response options was utilized to assess participants' understanding of CVRFs and healthy lifestyle practices, with a maximum possible score of 120 points. A high level of knowledge was defined as correctly answering over 75% of the items or scoring at least 90 points on the scale. Participants in the mHealth group exhibited notably greater understanding of healthy lifestyle practices and cardiovascular risk factor management after using the app compared with those in the control group, with a mean (SD) score of 118.70 (2.65) points in the mHealth group compared with 111.25 (9.05) points in the control group (P < .001). However, therapeutic adherence showed similar improvements in both groups by the end of the follow-up period, with no statistically significant variances observed between them.

"Knowledge of the risk factors for the disease is an essential requirement for patients to decide to adopt behaviors in line with a healthy lifestyle," the authors said. "However, people also need to be motivated to incorporate such behavior into their daily lives. Innovative mHealth technology could help to achieve both objectives by increasing the patients' knowledge and motivation."

In terms of quality of life, patients in the intervention group demonstrated significantly better scores in the physical component compared with the control group, while both groups showed similar scores for the mental component. Although the mHealth group showed slightly better scores in the well-being index, the difference did not reach statistical significance. Regarding overall satisfaction with health care, patients in the mHealth group rated their experience higher than those receiving standard health care, with mean (SD) scores of 48.22 (3.89) points and 46.00 (4.82) points, respectively, out of a maximum of 50 points (P = .002).

"More studies are required to examine the impact of smartphone interventions on people who have undergone a coronary event, with long-term follow-ups that analyze mortality and cardiac-cause hospitalization, because these are important yardsticks of the success of secondary prevention strategies that make it possible to establish the clinical importance of the findings," the authors concluded. "Cost analyses are also required to promote the generalized use of these tools, their implementation, and their feasibility."

References

Bernal-Jiménez MÁ, Calle G, Gutiérrez Barrios A, et al. Effectiveness of an interactive mhealth app (EVITE) in improving lifestyle after a coronary event: randomized controlled trial. JMIR Mhealth Uhealth. 2024;12:e48756. Doi:10.2196/48756

Percutaneous coronary intervention (PCI). Yale Medicine. Accessed April 24, 2024. Https://www.Yalemedicine.Org/conditions/percutaneous-coronary-intervention-pci

Watch As Gran's Life Is Saved When Doctors Replace Her Artery With 'frozen Elephant Trunk' In Groundbreaking Op

A GRANDMA's life was saved when doctors replaced her artery with a 'frozen elephant trunk' in a groundbreaking op.

Jeanette, 70, was in desperate need of surgery, as her aorta - the body's biggest artery - was diseased and threatening to rupture.

Jeanette's artery was replaced with 'frozen elephant trunk'Credit: BBC

Surgeons at University Hospital Southampton performed the high-risk procedureCredit: BBC

The widow's aortic valve at the top of her heart is also leaking - a defect that can cause heart failure.

"Having an enlarged aorta and a leaky heart is like a time bomb," consultant cardiac surgeon Amit Modi explained.

During an episode of BBC's popular series Surgeons: At the Edge of Life, Amit and his team from the Univeristy of Southampton can be seen performing a high-risk procedure to repair both conditions and give Jeanette a healthy future.

The operation, which can take all day to complete, involves a group of doctors removing and replacing the damaged section of the aorta with a synthetic tube.

The tube, bizarrely called a frozen elephant trunk, is stitched to replace Jeantte's aorta.

Amit can then be seen removing the faulty aortic valve before sewing in a new one made of animal tissue.

"This is not a routine procedure, and the stakes are high," Amid explained.

It amazes me how I can stop and restart the heart every time I do this operation

Amit ModiConsultant cardiac surgeon

During the procedure, her heart is stopped, and her body is attached to a heart-lung bypass machine, which will oxygenate and pump blood around her body temporarily.

Lee Allentuck's Successful Bypass Surgery

For Lee Allentuck, it was only a matter of time before heart disease caught up with him. 

"My dad died from a heart attack, my grandfather had bypass surgery, and my two brothers have heart issues," Lee said.  

So, it was no surprise to him when last year he felt pressure in his chest. 

"It would happen whenever I exerted myself, while I was simply walking or mowing the lawn. I couldn't walk 20 yards without feeling short of breath and pressure in my chest. So, knowing our family history, and the fact that my dad had just died in April from a heart attack, I reached out to my primary care physician," Lee said. 

Even before visiting his primary care physician, Lee, cognizant of his family history, had seen a cardiologist a year before his symptoms began. He had already been taking cholesterol medications since the age of 15. The Baystate cardiologist, who other than treating his high cholesterol, found him to be healthy with a "great" EKG, heart rate, and blood pressure. But, with the new feelings of chest pressure a year later, he decided first to consult his primary care physician. 

"I considered myself otherwise in good shape, walking and running, but the new EKG ordered by my primary care physician and a later stress test showed there was 'something happening.' So, I was referred back to my cardiologist who after ordering a cardiac catheterization, found that I had one artery 100% closed and three others that were mostly closed," Lee said.  

At first it was thought that medications could regulate his heart and symptoms, but surgery was ultimately decided as the best option, and Lee was referred for surgery and met with  Baystate cardiac surgeon Dr. Siavash Saadat. 

In preparation for his quadruple bypass surgery, which occurred on October 18, 2023, Lee, who had just turned 53, began working with Baystate's Cardiac Rehabilitation team in what they call "prehab." 

"The team was fantastic, I can't say enough about them and their encouragement, knowledge and honesty in helping me throughout my ordeal and preparing me for what was about to come," Lee said. 

"The doctors and nurses at Baystate saved my life. The way they work with their patients is amazing, very personalized. Heart surgery is a hard thing for anyone to go through and they made it feel so much easier," he added. 

Complex bypass surgery is one of the most performed major surgical procedures worldwide and the most common procedure performed by cardiac surgeons. It is referred to by some surgeons as "one of the most significant surgical achievements of the 20th century." Also referred to as coronary artery bypass grafting (CABG), it is used to improve blood flow to the heart. It may be needed when the arteries supplying blood to the heart, called coronary arteries, are narrowed or blocked. CABG uses healthy blood vessels from another part of the body and connects them to blood vessels beyond the blocked artery. This creates a new route for blood to flow that bypasses the narrowed or blocked coronary arteries. The blood vessels used most often are arteries from the chest wall or veins from the legs. During traditional "open-heart" CABG, your heart is stopped, and a heart-lung bypass machine takes over the job of pumping blood throughout the body.  

"It's unfortunate for this to happen to someone relatively young and in great shape with no other health problems and who is doing everything right - taking his medications as prescribed, keeping active, not smoking and so much more. But genetics, as evidenced in his family history, plays a strong role in heart disease," said Dr. Saadat. 

"Given the location and severity of the blockage it made the most sense to pursue bypass surgery to restore blood flow and for overall durability and longevity. We also knew he was a good candidate to withstand the surgery based on his age and otherwise good health," he added. 

Lee agreed. 

"I said, 'Let's just do it and not wait,' knowing I was young enough at the time to recover faster. And Dr. Saadat was amazing and super supportive. He walked my wife, Gianna, and I through the entire procedure and answered all our questions," he said. 

Still, Lee had some qualms, but not about if the surgery would be successful - instead how his family would react and about the recovery process. 

"You don't want your children, who see you as a stoic figure in their lives, to see you so vulnerable lying in the hospital bed. Also, it was the fear of knowing I would have a lot of work ahead of me to regain my health," he said about his two children, Sontino, 21, and Cecilia, 18. 

But the Longmeadow resident was well prepared. 

"The team in prehab were very open with me about what my recovery would be like. They prepared me to be physically and mentally ready for what was ahead of me. And, while there, because I couldn't run or do many things, I got in some monitored exercise to build my strength before the operation," said Lee, who today continues his cardiac rehab. 

"We have a world-renowned Cardiac Rehabilitation Program at Baystate which is led by its medical director, preventive cardiologist Dr. Quinn Pack, who is one of the nation's leading experts in cardiac health. During the program, cardiac patients not only receive the exercise they need to remain strong and healthy, but education on healthy eating, how to reduce your addiction to tobacco, and other important risk factor reduction strategies including diabetes control," said Dr. Saadat. 

"Today we know that beginning a cardiac rehab program before surgery helps to prime the body to withstand the stressors of bypass surgery and has been shown to improve outcomes and quality of life for our patients throughout the process - before, during and after surgery," he added. 

After spending one night in the cardiac intensive care unit and less than a week in the hospital, Lee returned home to his wife after the successful quadruple bypass surgery and is "pretty much back to normal," he said. 

In addition to the extraordinary support of his doctors and rehab team at Baystate, Lee also had a champion at home. 

"My wife had her own health issues and was diagnosed with non-Hodgkin's lymphoma after we got engaged. We worked together to get through it all and that served as a good template for supporting each other throughout our marriage. She is my rock, and it is fantastic to have a partner who is so supportive of you in anything you may be going through," he said. 

But it wasn't just his wife and children supporting him. 

"So many people came out to support us - friends, family, colleagues. People came to take me for walks and get me up and moving. People called. Visited. Sent notes and texted. They still do to this day - checking in on me and sending support and positivity. It was really amazing to feel the love from the community and extended family and friends. I believe this was a huge part of my recovery," said Lee. 

Today, Lee continues his work as a consultant in the toy and game industry after having worked for Hasbro in East Longmeadow and LEGO in Enfield, CT for many years. He also finds the time to volunteer and give back to the community in many ways, including what he calls "almost a second job" - nurturing young minds in technology and engineering at Longmeadow High School where he has been coaching robotics for the past 12 years in a cleverly named program called LongMetal Robotics.   

"The program is focused on spreading STEM learning throughout the community through hands-on experience and competitive robotics. I started the program when my son was in 5th grade and we continue to expand it to impact as many kids in our community as possible. A Our program is designed to give back to the community as part of its mission. We promote STEM learning through our Robotics Camps, STEM Activity Evenings, and a middle school robotics program. This year, we made bookmarks to send to the US Coast Guard Academy cadets to support their efforts in protecting our country," Lee said. 

Community service is important to the Allentuck family. 

"Inherited from my parents and shared with Sontino and Cecelia, the belief in the power of community service runs deep in our family. It's this conviction that makes my involvement with LongMetal Robotics far more than a professional endeavor - it's a personal mission. Here, technology meets empathy, creating more than just innovative solutions - we're fostering a sense of community and responsibility. Alongside my wife, we endeavor to embody this spirit of service, contributing to the fabric of our community where we can and teaching our children that true fulfillment comes from giving," he said. 

More information on LongMetal Robotics is available at www.LongMetal.Org 

Lee has a message for those considering cardiac bypass surgery. 

"There is no reason to look any further than Baystate Medical Center for your cardiac surgery. Dr. Saadat, who trained in Boston, was incredibly confident about performing the surgery and put me at ease right away," he said. 

Baystate Medical Center is home to the only cardiac surgery program in western Massachusetts and the program is recognized with a prestigious 3-star ranking by the Society of Thoracic Surgeons. 

Dr. Saadat also has a message. 

"While you cannot control the DNA you are given, we can work together to implement lifestyle changes that can have strong lasting effects to improve heart health," he said. 

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