Coronary heart disease (CHD) is a leading cause of death in Taiwan and a major
contributor to premature and avoidable mortality worldwide. Cardiac rehabilitation (CR)
is a multidisciplinary secondary prevention strategy that has been widely proven to
reduce morbidity and mortality. However, despite its well-documented benefits, CR remains
underutilized due to barriers such as transportation, time constraints, and limited
access to facilities. Tele-cardiac rehabilitation (tele-CR), a technology-enabled
alternative to traditional center-based CR, has been shown to be both safe and effective
in improving clinical and behavioral outcomes. Nevertheless, research on the
implementation and effectiveness of tele-CR in Taiwan is still limited.
This project spans a three-year period and is divided into two phases. The present study
represents the second phase and aims to evaluate the short- and long-term effects of a
six-month tele-CR program in patients with CHD. The primary outcomes include quality of
life, self-efficacy, self-management, medication adherence, and mental health status
(anxiety and depression). In addition, a comprehensive set of metabolic parameters will
be assessed, including BMI, SBP, DBP, FBG, HbA1C, and lipid profile markers such as TG,
TC, HDL, and LDL.
The research hypotheses are as follows: the tele-CR program will (1) improve quality of
life, self-efficacy, self-management, and medication adherence; (2) reduce levels of
anxiety and depression; and (3) lower blood pressure, blood glucose, BMI, and lipid
levels, with these effects being sustained up to 12 months post-discharge.
A single-blind, attention-controlled, prospective, randomized clinical trial will be
conducted in the cardiology ward of a medical center in northern Taiwan from September 1,
2025, to August 31, 2027. A total of 126 patients diagnosed with CHD will be purposively
recruited upon admission. After completing baseline assessments, participants will be
randomly assigned in blocks to either the experimental group (n = 63) or the control
group (n = 63). The experimental group will participate in a six-month tele-CR program,
consisting of in-hospital motivational interviews, mobile application support,
self-management education, and seven scheduled follow-up calls. The control group will
receive standard care plus seven routine care calls over the same six-month period
following discharge. Both groups will continue to receive usual medical and nursing care
throughout the study.
This study has been reviewed and approved by the Institutional Review Board (IRB) of the
study hospital. Research assistants will explain the study's objectives and procedures in
detail to all eligible participants. Informed written consent will be obtained only after
participants' questions have been addressed. Questionnaire data will be collected either
via self-administration or with assistance from trained research personnel, based on
participant preference. All data collection will take place in a quiet and private
environment to ensure accuracy and participant comfort.
Data will be collected at baseline and at 3, 6, 9, and 12 months after discharge, using
structured questionnaires and medical records. Baseline values for metabolic indicators
will be based on the closest hospitalization date within the three months prior to
admission. Post-discharge values will be based on the closest record to the date of each
questionnaire completion.
All statistical analyses will be performed using SPSS version 26.0. Descriptive
statistics (frequencies, percentages, means, and standard deviations) will summarize the
participant characteristics and study variables. An intention-to-treat approach will be
adopted. To examine the short- and long-term effects of the intervention, generalized
estimating equations (GEE) will be used. A two-tailed test with a significance level of p
< 0.05 will be considered statistically significant.
