Effect of Nurse-Led eHealth Cardiac Rehabilitation Incorporating Mindfulness as a Stress Management Component for Patients with Coronary Heart Disease: A Pilot Randomized Controlled Trial

Introduction: eHealth cardiac rehabilitation (CR) is an effective, cost-saving, and feasible alternative to center-based CR, a standard treatment, for patients with coronary heart disease (CHD). Despite substantial evidence highlighting the consequences of stress on CHD disease deterioration, stress management is less included in eHealth CR with exercise being consistently emphasized as the cornerstone. This study aimed to examine the effects of a comprehensive eHealth CR program incorporating mindfulness as a stress management component on psychological wellbeing and related health outcomes in patients with CHD. Methods: A single-blind pilot randomized controlled trial compared a 12-week nurse-led eHealth CR program integrating mindfulness with usual care. Participants were recruited from community rehabilitation centers. The intervention included individualized assessment, goal setting, telemonitoring, online education, and guided mindfulness audios. Outcomes, including perceived stress, anxiety, depression, and daily step count, were assessed at baseline, 6 weeks, and 12 weeks using validated scales and accelerometer data. Results: A total of 41 participants were recruited, with 20 in the intervention group and 21 in the control group. Participants were middle-aged/older adults (mean = 56.56, standard deviation [SD] = 9.53), and most were male (80.5%, n = 33), married (85.4%, n = 35), and co-reside with their family (90.2%, n = 37). Referring to the generalized estimating equations analysis, participants in the intervention group showed significantly lower anxiety level (β = −3.49, P = 0.001) compared to the control group at 12-week post-intervention, with a large effect size of 1.58, and greater daily steps (β = 1,633, P = 0.02) at 6-week post-intervention but not at 12 weeks. The intervention was feasible, with 100% initiation of allocated care. Overall, 43.9% of participants completed both subjective and objective data collection, and 85.4% completed at least one of the two. There were no significant between-group differences in perceived stress and depressive symptoms. Conclusion: A 12-week, empowerment-oriented eHealth CR program can effectively engage patients, reduce anxiety, and increase physical activity. These findings support the value of theory-informed, nurse-led digital interventions for promoting patient activation and self-management in CHD. Building on these results, future research should examine maintenance and scalability.