A Digitally-Supported Shared Decision Making Approach for Patients during Cardiac Rehabilitation: a Randomized Controlled Trial

The aim of the study is to evaluate the effectiveness of combining center-based cardiac rehabilitation (CR) with shared decision making (SDM) based telerehabilitation (TR) on patients' quality of life, cardiorespiratory fitness, and physical activity level. A randomized controlled trial (NCT05026957) was conducted with 80 patients with heart disease recruited from Jessa Hospital, Hasselt. Patients were randomized to either a control group receiving standard CR or an intervention group receiving standard CR with additional SDM-based TR via the SharedHeart smartphone application. Primary outcome was quality of life (HeartQoL), while secondary outcomes included cardiorespiratory fitness (VO2peak) and physical activity levels. Data were analyzed using a linear mixed model. The intervention group showed a greater improvement in quality of life (4.15 points, 95% CI: 0.7-7.6; p = 0.02), peak oxygen uptake (VO₂peak) (1.1 ml/kg/min, 95% CI: 0.04-2.1; p = 0.04), and number of step count (14 788 more steps/7 days (95% CI: 4,2-25,3; p < 0.01)) over a 12-week intervention, compared to the control group. This study demonstrated that the addition of SDM-based TR program to center-based CR significantly improved patients' quality of life, cardiorespiratory fitness, physical activity levels compared to center-based CR alone. The SharedHeart study stands out as one of the first to integrate a digitally-supported SDM approach in CR, empowering patients to take an active role in their rehabilitation. Future research should focus on the long-term impact of digital interventions, particularly in reducing adverse cardiovascular events and enhancing patient self-management.