HERBEAT: HEalthy HeaRts and Optimized BEhaviors via Adaptive App-delivered Technologies - HERBEAT: HEalthy HeaRts and Optimized BEhaviors via Adaptive App-delivered Technologies Project Abstract Coronary heart disease (CHD) afflicts 8.8 million American women annually, making it their leading cause of morbidity worldwide. Despite the well-established benefits of center-based cardiac rehabilitation (CBCR) as the gold standard for secondary prevention (SP), women face significant challenges to participation. Compared with men, women have lower referral rates to CBCR, enrollment as low as 10%, and up to 72% non-completion rates. These constraints highlight the urgent need for redesigned SP alternatives that provide personalized, technology- enhanced behavior change interventions. Traditional rehabilitation programs focus on short-term intervention, whereas secondary prevention for CHD should emphasize long-term cardiovascular health optimization. Our preliminary data indicate that HerBeat, a mobile health (mHealth) intervention has the capacity to implement theory-based behavior change techniques, expand access to women without CBCR availability, and integrate interventions seamlessly into daily life using Just-In-Time Adaptive Interventions (JITAIs). To evaluate HerBeat’s effectiveness, we will conduct a rigorous randomized controlled trial (RCT), comparing HerBeat with Educational Usual Care (EUC) across multiple outcomes. In a randomized controlled trial we will (1) evaluate whether HerBeat compared to an educational usual care (EUC) group improves exercise capacity, the primary outcome (improvement in the six-minute walk test (6MWT)) relative to baseline at 3 months and 6 months; (2) evaluate whether HerBeat compared to EUC improves the secondary outcomes, quality of life (QOL), physical activity (PA), body mass index (BMI), waist circumference, blood pressure (BP), tobacco use, medication adherence, depressive symptoms, anxiety, and perceived stress at 3 months and 6 months; and (3) determine the impact of HerBeat on health services utilization and costs. HerBeat leverages wearable and mobile technology to optimize SP delivery. The intervention utilizes a smartwatch and smartphone system to track and enhance adherence. A goal-setting platform encourages personalized health commitments. JITAIs deliver targeted behavior change techniques. HerBeat provides instant progress reports for real-time behavior tracking and machine-learning algorithms monitor physical activity training. Thirty educational videos are available to support behavior change and participants receive health coach monitoring via a web portal dashboard. A peer support system is available through an in-app chat function and daily ecological momentary assessments (EMAs) track activities and performance trends. We will: 1) Enroll 250 women with CHD, randomly assigned to either HerBeat or EUC; 2) Collect primary and secondary outcome data over 6 months; and 3) Assess cost implications of both interventions. The research supports a critical paradigm shift away from a reactive, visit-based healthcare model toward a proactive, personalized approach that is accessible anytime and anywhere, seamlessly integrated into participants’ daily lives, and scalable to all women with CHD, not just those eligible for CBCR.
