The Effectiveness of Nurse-Led Multidimensional Digital Cardiac Rehabilitation in Patients With Unstable Angina Undergoing Percutaneous Coronary Intervention: Emulated Target Trial

Background: Cardiac rehabilitation (CR) interventions for patients with coronary heart disease are increasingly adopted. However, research on the integration of digital health technologies into CR for patients with unstable angina (UA) undergoing percutaneous coronary intervention (PCI) remains limited. Objective: This study assessed the effectiveness of a multidimensional digital CR program for patients with UA undergoing PCI. Methods: This prospective study enrolled 164 patients with UA who underwent PCI between April and June 2022. Patients were assigned to either the usual care group (April-May 2022) or the multidimensional digital CR intervention group (May-June 2022). The intervention group received rehabilitation through a nurse-led, multidisciplinary team, using a customized digital CR program. This program encompassed 7 key rehabilitation components: exercise, medication management, nutritional guidance, psychological support, sleep management, health education, and smoking cessation assistance. The usual care group received standardized treatment and routine nursing care. To minimize selection bias, propensity score matching was applied between the 2 groups. The primary outcomes included changes in the 6-minute walk test (6MWT), 12-item Short Form Health Survey (SF-12) scores, and frailty phenotype scores at 3 months. Secondary outcomes assessed differences in gait speed, 30-second chair stand test (30-s CST), grip strength, waist circumference (WC), BMI, and lipid profiles at 3 months. Results: A total of 136 patients were included in the final analysis. At 3 months, the intervention group demonstrated significant improvements in frailty status compared to the control group. The proportion of prefrail patients decreased from 100% (68 patients) to 75% (51 patients), while nonfrail patients increased from 0% to 25% (17 patients; P<.001). Regarding physical fitness, the intervention group exhibited improvements in 6MWT: from 347.06 (SD 32.43) to 375.22 (SD 29.71) m (P<.001); gait speed: from 0.87 (SD 0.17) to 1.05 (SD 0.14) m/s (P<.001); and 30-s CST: from 10.0 (SD 1.89) to 12.71 (SD 1.97; P<.001). Grip strength, BMI, and WC improved significantly in the intervention group. Grip strength increased from 16.64 (SD 6.57) to 20.74 (SD 5.37; P<.001). BMI decreased from 25.74 (SD 3.05) to 23.88 (SD 2.14; P<.001), and WC decreased from 94.98 (SD 7.87) to 89.91 (SD 7.50) cm (P<.001). The intervention group achieved greater improvements in lipid profiles, with significant reductions in total cholesterol (P<.001), triglycerides (P<.001), and low-density lipoprotein cholesterol (P<.001), while high-density lipoprotein cholesterol remained stable (P=.45). Conclusions: This study demonstrates that a novel multidimensional digital CR program is acceptable and effective in improving functional status and health-related quality of life in patients with UA undergoing PCI within a short timeframe.