
==== Front
Medicine (Baltimore)
Medicine (Baltimore)
MD
Medicine
0025-7974
1536-5964
Lippincott Williams & Wilkins Hagerstown, MD

MD-D-23-11045
00087
10.1097/MD.0000000000039497
3
3400
Research Article
Observational Study
Exploring the effects of an online learning platform in stage III cardiac rehabilitation for individuals with coronary heart disease: Randomized controlled study
Ma Li-Chao BD lichaomm@skiff.com
ab
Liu Juan MM jliu_dr09@21cn.com
c
Jiao Cui-Liu MM clcljiao@skiff.com
a
Du Shao-Ying MM dudusysy@skiff.com
a
Zhang Ruo-Lan BD lanrlrldr99@skiff.com
a
Ding Xiao-Juan BD xiaojuanxj87@skiff.com
a
Shi Xiao-Yang MM xyang_drsea6@21cn.com
a
https://orcid.org/0000-0003-3022-8252
Wang Yan MM a*
a School of Nursing, Hebei University, Baoding, China
b Operating Room, The Fourth Hospital of Hebei Medical University, Shijiazhang, China
c Department of Rehabilitation Medicine, Affiliated Hospital of Hebei University, Baoding, China
* Correspondence: Yan Wang, School of Nursing, Hebei University, Baoding City, Hebei Province 071000, China (e-mail: ywang_dr06@163.com).
13 9 2024
13 9 2024
103 37 e3949707 12 2023
03 7 2024
08 8 2024
Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

The objective of this study is to assess the influence of blended education methodologies, utilizing an online education platform, among stage III cardiac rehabilitation (CR) patients diagnosed with coronary heart disease (CHD). Between June and August 2021, a cohort of 90 patients diagnosed with CHD, previously discharged from a second-class hospital 1 year earlier, were randomly allocated into 2 groups: the experimental and control groups, with each comprising 45 patients. Patients in the control group received out-of-hospital CR education via WeChat, while those in the experimental group received blended CR education utilizing an online education platform. Following a 24-week period, the self-management behavior and negative emotions of both groups were compared before and after the intervention. The final count of patients in the control and experimental groups was 39 and 37, respectively. Post the intervention, in terms of self-management behavior, the control group achieved an average score of 90.69 ± 7.13, while the experimental group scored 96.11 ± 5.42 (P < .05). Concerning negative emotions, the anxiety scores for the control and experimental groups were 3.03 ± 2.63 and 1.86 ± 1.80, respectively, and the depression scores were 3.00 (3.00) and 2.00 (3.00), respectively (P < .05). The differences in the outcomes mentioned above were statistically significant. The implementation of a blended educational approach utilizing an online platform has resulted in notable improvements in self-management skills and the reduction of negative emotions among patients with CHD. As a result, this educational strategy has demonstrated effectiveness in providing post-discharge CR education for patients with CHD.

blended education
cardiac rehabilitation
coronary heart disease
online education platform
randomized controlled study
self-management
Science and Technology Program of Hebei18277735D Yan WangOPEN-ACCESSTRUE
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pmc1. Introduction

Coronary heart disease (CHD) stands as a prominent noncommunicable disease, presenting a significant threat to human health.[1] According to projections from the World Health Organization (WHO), CHD is anticipated to contribute to 13.1% of all global fatalities by 2030.[2] In China, the burden of CHD is evident, with approximately 11 million individuals affected, a number that continues to escalate.[3] The management of CHD primarily revolves around revascularization through surgical procedures and ongoing medication regimes.[4] Despite the efficacy of these treatments in improving long-term outcomes, they remain insufficient in adequately addressing CHD, a chronic condition that necessitates lifelong management.

Cardiac rehabilitation (CR) encompasses a multifaceted approach involving medication, physical exercise, dietary guidance, psychological support, and smoking cessation advice. This comprehensive intervention aims to reduce hospital readmissions, lower mortality rates, mitigate risk factors, and enhance the quality of life for individuals with CHD, playing a crucial role in ongoing patient care.[5]

The CR program is structured into 3 stages: stage I, conducted within the hospital; stage II, comprising early rehabilitation outside the hospital; and stage III, which involves long-term rehabilitation outside the hospital. Stage III holds particular significance for patients with CHD, who are often in this phase. It is noteworthy that prominent medical associations such as the American Heart Association, the American College of Cardiology, and the European Society of Cardiology strongly advocate for CR, considering it a Class IA treatment for cardiovascular disease.[6] Additionally, they endorse stage III home-based CR as a viable alternative to facility-based rehabilitation.

Despite these endorsements, CR encounters global challenges characterized by low referral rates, limited participation, and suboptimal adherence rates.[7] It is evident that adherence to CR presents difficulties for patients with CHD, highlighting the urgent need for innovative CR strategies. Thus, the development of effective intervention approaches is paramount to assist CHD patients in effectively managing their chronic condition.

In recent years, there has been a heightened recognition of CHD, underscoring the importance of reinforcing health education for affected patients.[8] Regrettably, in China, only a fraction of CHD patients have received adequate CR education, with even fewer benefiting from tailored rehabilitation plans.[9] Traditional discharge instructions, constrained by limited medical and health education resources, often yield suboptimal results.

Presently, the WeChat platform offers a promising avenue for delivering post-discharge education, providing patients with continuous access to information. However, its simplicity may not adequately address the diverse needs of individual patients, and the ongoing influx of information can overwhelm users. Hence, there is a pressing need to explore more convenient, efficient, and personalized education strategies to bolster patients’ long-term self-management capabilities concerning CR post-discharge. This approach aims to facilitate adherence to CR management requirements and ultimately enhance cardiac function.

Online learning platforms provide a plethora of instructional methods and robust features that effectively engage students’ curiosity, enhance their academic performance, and elevate the overall quality of education during the learning process.[10] With their user-friendly interface and diverse educational capabilities, these platforms prove to be more effective for health education compared to platforms like WeChat. Blended education, an emerging pedagogical approach that seamlessly integrates online and offline teaching, facilitates a more comprehensive understanding of theoretical concepts and the development of practical skills among patients. This approach fosters active learning and significantly boosts motivation among patients to actively participate in their educational journey.[11,12] Furthermore, blended education surpasses traditional health education methods in its ability to promote knowledge acquisition.[13]

Therefore, our objective was to implement a blended educational approach that combines both online and in-person instruction utilizing an online educational platform. We aimed to examine the impact of this approach on the CR education of patients with CHD post-discharge, as well as their ability for self-management, through a randomized controlled study.

2. Methods and analysis

2.1. Trial design

For this study, we employed a randomized controlled design, where participants were randomly assigned to either the experimental group or the control group. All patients received standard CR education during their hospital stay. However, in addition to this, the experimental group received a blended CR education program through an online platform, while the control group received their CR education via WeChat outside the hospital setting. Both groups underwent a 24-week intervention, with data collected before and after this period. We conducted comparisons of various relevant indicators between the 2 groups. A graphical representation of the research process is depicted in Figure 1 as a flowchart.

Figure 1. Flowchart of the study participants.

3. Sample size

The primary outcome in this study was self-management behavior, and we accordingly determined the required sample size. We employed a hypothesis test comparing the means of 2 samples, with the formula N = 2(μα+ μβ)2σ2/δ2. For this study, we assumed α = 0.05 and β = 0.2 for a 2-sided test, as indicated in prior research.[14] Based on these parameters, we calculated that each group would need 35 patients. To account for potential sample loss of 20%, the final decision was to enroll 45 patients in each group, resulting in a total sample size of 90 patients.

4. Participants

4.1. Inclusion criteria

Individuals who have received a confirmed diagnosis of CHD based on the 2019 European Society of Cardiology criteria.[15]

Patients with CHD at low risk, 1 year after being discharged from the hospital following cardiovascular events.

Individuals between the ages of 18 and 75.

Individuals who own and actively use a smartphone with an active WeChat account.

Individuals with normal cognitive abilities, reading skills, and comprehension.

Individuals who willingly choose to take part and provided informed consent.

5. Exclusion criteria

Individuals with other medical conditions that make exercise rehabilitation unsafe, such as malignant rapid arrhythmia or severe valve dysfunction.

Individuals who face challenges in effective communication due to language barriers or limitations in expression.

Individuals with restricted physical activities due to any medical condition.

6. Setup and recruitment

Between June and August of 2021, a cohort of 90 patients who met the specified inclusion and exclusion criteria underwent evaluation in the case ward of a second-tier hospital situated in Baoding City, Hebei Province. Following this evaluation, they were randomly assigned to either an experimental group or a control group. This study was conducted with approval from the Ethics Committee of the Affiliated Hospital of Hebei University (No: HDFYLL-KY-2023-130). This study was conducted in accordance with the declaration of Helsinki. Written informed consent was obtained from all participants.

7. Randomness, allocation concealment, and blinding

The random number table was utilized to allocate participants into either the control or experimental group according to the following procedure: Participants were assigned numerical labels from 01 to 90. To determine the allocation for each participant in the control group, we commenced with the numbers located in column 5, row 3 of the random number table, and sequentially obtained random numbers in the same direction. These random numbers were then divided by the number of groups, which was 2. The resulting remainder dictated the group assignment for each patient. If the remainder equaled 0, the patient was assigned to the experimental group; if the remainder was 1, the patient was assigned to the control group (Fig. 1).

8. Interventions

8.1. Preparations

We assembled an expert team of CR education professionals, consisting of cardiovascular doctors, cardiovascular nurses, and rehabilitation specialists who underwent training to become certified CR trainers. Their responsibility was to assess and enhance the CR education materials for 2 patient groups, and we made adjustments to the educational program based on their feedback. Throughout the educational process, personalized education plans were developed for each patient, with the expert team also reviewing and refining these individualized plans.

9. The control group received WeChat-based CR education

We established a WeChat group where, during the first week, the expert team disseminated revised CR education materials to patients through text, images, videos, and other multimedia formats, empowering patients to self-educate. Over the subsequent 24 weeks, the expert team promptly addressed patient inquiries within the WeChat group.

10. The experimental group received blended CR education based on the online teaching platform:

We registered on an online teaching platform, where we created CR education courses and uploaded expert-reviewed materials as chapters. These covered topics like CHD and CR introduction, exercise therapy, medication, psychological and sleep therapy, dietary guidance, and smoking cessation methods, mirroring the content provided to the control group.

Employing the “Homework” feature, we regularly posted patients’ self-assessment assignments on the platform biweekly. These assignments covered a range of aspects including adherence to dietary recommendations, exercise routines, medication usage, and management of tobacco and alcohol. Following completion, investigators provided personalized supervision, tailored to each patient’s self-assessment, ensuring individualized support and guidance.

We utilized the “learning situation analysis” tool to monitor each patient’s task completion, facilitating personalized one-on-one supervision. This approach ensured tailored support and guidance for every individual.

Personalized supervision entailed providing encouragement to patients demonstrating a positive learning attitude and progress in their behavior. Furthermore, individuals who were less active or showed limited improvement received additional tailored guidance.

Patients received notifications regarding their learning progress and reminders to submit behavior evaluation assignments. Health-related inquiries were addressed via WeChat group chats.

In instances where individual patients encountered challenges beyond resolution through the online teaching platform or WeChat, face-to-face communication was utilized, considering the patients’ preferences. This approach facilitated personalized guidance, enhancement of motivation, and demonstration of behavioral skills, as illustrated in Figure 2.

Figure 2. Application process of blended education strategy based on network teaching platform.

11. Outcome measures

In evaluating CHD secondary prevention strategies, we focused on 3 crucial aspects: self-care actions and emotional well-being. To gather comprehensive data, we utilized various assessment instruments, including the General Condition Questionnaire, Coronary Heart Disease Self-Management Scale, Generalized Anxiety Disorder Scale, and Patient Health Questionnaire. These tools provided insights into patients’ self-care behaviors and emotional states, facilitating a comprehensive assessment of CHD secondary prevention efforts.

12. General condition questionnaire

The General Condition Questionnaire encompasses a range of demographic details, including age, gender, educational attainment, employment type, employment status, and household earnings. Moreover, it delves into health-related data, such as the progression of the illness, familial medical background, the presence of concurrent health conditions, and any prior stent or bypass procedures undergone by the participant.

13. Coronary Heart Disease Self-Management Scale (CSMS)

The assessment tool, created by Chinese researcher Ren Hongyan,[16] comprises 7 dimensions and 27 items. It employs a 5-level Likert scale: always, often, sometimes, barely, and never, which correspond to scores of 5, 4, 3, 2, and 1, respectively. Higher scores indicate more effective patient self-management behavior. The reliability analysis yielded a Cronbach alpha coefficient of 0.921, a retest reliability of 0.910, and a benchmark reliability ranging from 0.271 to 0.573.

14. Generalized Anxiety Disorder-7 (GAD-7)

In 2007, Spitzer et al,[17] employed this scale for anxiety screening. Chinese scholars, including He Xiaoyan,[18] subsequently adapted it into a Chinese version. The scale comprises 7 items, utilizing a 4-level Likert scoring system, namely “never,” “several days,” “more than half of the time,” and “almost every day,” corresponding to scores of 0, 1, 2, and 3, respectively. The total score ranges from 0 to 21 points. The scale exhibits robust reliability and validity, as indicated by a Cronbach alpha of 0.898 and a retest reliability of 0.856.

15. Patient Health Questionnaire-9 (PHQ-9)

The development of the PHQ-9 scale was guided by the criteria delineated in the American Diagnostic and Statistical Manual of Mental Disorders,[19] and its utility extends to diverse medical domains. The adaptation of this scale for Chinese usage was meticulously refined by a team of Chinese scholars spearheaded by Bian et al.[20] Comprising 9 items, this questionnaire employs a nuanced 4-level Likert scoring system, with responses ranging from “never” to “almost every day,” correlating to scores of 0, 1, 2, and 3, respectively. The cumulative score ranges from 0 to 27 points. The Chinese iteration of this scale showcases robust reliability and validity, underscored by a Cronbach alpha coefficient of 0.857 and an internal consistency coefficient of 0.857.

16. Data collection and management

The electronic health records of discharged patients were meticulously accessed and reviewed with full authorization and support from the hospital’s relevant medical staff. Following this initial step, we actively reached out to recently identified patients diagnosed with CHD via telephone to provide detailed explanations regarding the study’s objectives, significance, and to gauge their interest in participation. For those expressing willingness to take part, we efficiently scheduled appointments to collect their baseline data at the department’s teaching facility, complemented by an informative session on CR. The data collection process was executed with precision by a proficient team comprising investigators and trained members, who administered questionnaires both prior to the intervention and again after a 24-week interval. To ensure data reliability, stringent measures such as data cleansing, encoding, and transformation were meticulously applied to ensure optimal data formatting for subsequent analysis. The securely stored data was maintained on a professional-grade computer within a secure environment. The compilation and subsequent statistical analysis were conducted under the supervision of experienced statistical specialists affiliated with Hebei University.

17. Statistical analysis

We utilized SPSS version 22.0 for statistical analysis, where a significance level of P < .05 was deemed as statistically significant. For normally distributed measurement data, we represented them as mean ± standard deviation, and performed a 2 independent samples t-test for analysis. Data that did not conform to normal distribution are expressed as median (quartiles) [M (Q)], and the rank sum test of 2 independent samples (Mann–Whitney U test) was used for analysis. The counting data are expressed as frequency and percentage, and the Chi-squared test was used for analysis.

18. Results

18.1. Overview

After 24 weeks of the intervention, a total of 76 patients were ultimately enrolled, with 37 participants in the experimental group and 39 in the control group. Notably, the completion rate for the experimental group stood at 82.22%, while the control group boasted a completion rate of 86.67%. Figure 1 visually represents the flowchart outlining the recruitment, randomization, and attrition of participants throughout the trial. Furthermore, Table 1 provides a comprehensive overview of the demographic and disease-related characteristics of patients in both the experimental and control groups. Utilizing t-tests or chi-squared tests, it was determined that there were no significant differences between the 2 groups, thereby affirming their comparability.

Table 1 Demographic characteristics and health information of the 2 groups.

		All
(n = 76) (%)	Control
(n = 39) (%)	Intervention
(n = 37) (%)	t/χ 2	P value	
Age (years)		61.46 ± 8.15	61.79 ± 8.48	61.11 ± 7.89	0.365*	.716	
Sex	Male		20 (51.28)	18 (48.65)	0.053	.818	
	Female		19 (48.72)	19 (51.35)			
Marital status	Married	70 (92.10)	36 (92.31)	34 (91.89)	0.829†	.850	
	Divorced	3 (3.95)	1 (2.56)	2 (5.41)			
	Widowed	3 (3.95)	2 (5.13)	1 (2.70)			
Family members	1 person	3 (3.95)	2 (5.13)	1 (2.70)	0.716†	.724	
2 persons	30 (39.47)	14 (35.90)	16 (43.25)			
3 persons and above	43 (56.58)	23 (58.97)	20 (54.05)			
Education level	Primary school and below	6 (7.89)	4 (10.26)	2 (5.41)	5.920†	.115	
	Middle school or technical secondary school	42 (55.27)	19 (48.71)	23 (62.16)			
	High school or junior college	23 (30.26)	11 (28.21)	12 (32.43)			
	Bachelor;s degree or above	5 (6.58)	5 (12.82)	0 (0.00)			
Occupation	Worker	39 (51.32)	18 (46.16)	21 (56.75)	2.328†	.514	
	Farmer	13 (17.11)	6 (15.38)	7 (18.92)			
	Professional technical or managerial personnel	18 (23.68)	12 (30.77)	6 (16.22)			
	Others	6 (7.89)	3 (7.69)	3 (8.11)			
Working status	Employed	9 (11.84)	7 (17.95)	2 (5.41)	4.127†	.127	
Unemployed	17 (22.37)	6 (15.38)	11 (29.73)			
	Retired	50 (65.79)	26 (66.67)	24 (64.86)			
Per capita monthly household income (RMB)	≤ 1000	7 (9.21)	3 (7.69)	4 (10.81)	1.900†	.603	
1000 to 2000	12 (15.79)	5 (12.82)	7 (18.92)			
2000 to 3000	26 (34.21)	16 (41.03)	10 (27.03)			
> 3000	31 (40.79)	15 (38.46)	16 (43.24)			
Disease course	1 to 3 years	13 (17.11)	5 (12.82)	8 (21.62)	1.057	.590	
3 to 5 years	19 (25.00)	10 (25.64)	9 (24.33)			
> 5 years	44 (57.89)	24 (61.54)	20 (54.05)			
Family history	Yes	31 (40.79)	17 (43.59)	14 (37.84)	0.260	.610	
	No	45 (59.21)	22 (56.41)	23 (62.16)			
Comorbidities	Yes	69 (90.79)	34 (87.18)	35 (94.59)	0.519	.471	
	No	7 (9.21)	5 (12.82)	2 (5.41)			
Stent implantation or not	Yes	10 (13.16)	4 (10.26)	6 (16.22)	0.184	.668	
No	66 (86.84)	35 (89.74)	31 (83.78)			
Bypass or not	Yes	1 (1.32)	1 (2.56)	0 (0.00)	–	1.000†	
	No	75 (98.68)	38 (97.44)	37 (100.00)			
Note: Values with “*” are t values, values with “†” are Fisher exact test values, and the remaining values are χ2 values.

19. Self-management behavior and negative emotions comparison

19.1. Comparison of self-management behavior

An analysis utilizing a 2-sample independent t-test was conducted to compare the 2 groups both before and after the intervention. Prior to the intervention, no significant differences were observed between the 2 groups, as evidenced in Table 2. However, subsequent to 24 weeks of health education intervention, the experimental group exhibited a notably superior enhancement in their self-management behavior compared to the control group.

Table 2 Comparison of total scores of self-management behavior between the 2 groups (n = 76, points) (x¯±S).

	Before intervention	After intervention	
Control group (n = 39)	75.13 ± 10.84	90.69 ± 7.13	
Experimental group (n = 37)	78.11 ± 9.35	96.11 ± 5.42	
t	−1.280	−3.714	
P	.204	<.001	

20. Comparison of anxious emotion

Prior to the intervention (Table 3), there was no notable distinction in anxiety levels between the 2 groups. Nonetheless, after 24 weeks of health education intervention, a discernible enhancement in anxious feelings was observed within the experimental group compared to the control group. This difference signified a significant improvement in the experimental group’s emotional well-being following the intervention period.

Table 3 Comparison of anxious emotion (n = 76, points) (X¯±S).

	Before intervention	After intervention	
Control group (n = 39)	3.74 ± 3.58	3.03 ± 2.63	
Experimental group (n = 37)	4.27 ± 4.32	1.86 ± 1.80	
t	−0.580	2.234	
P	.564	.028	

21. Comparison of depressed emotion

To evaluate the 2 groups both before and after the intervention, a Mann–Whitney U test, which compares 2 independent samples, was utilized. The findings revealed no substantial variance in depression scores between the 2 groups prior to the intervention, as depicted in Table 4. However, following 24 weeks of health education intervention, a notable disparity emerged. The experimental group demonstrated a considerably more pronounced improvement in depressive emotions compared to the control group.

Table 4 Comparison of depressed emotion between the 2 groups.

	Before intervention	After intervention	
Control group (n = 39)	4.00 (4.00)	3.00 (3.00)	
Experimental group (n = 37)	4.00 (4.00)	2.00 (3.00)	
t	−0.099	−2.643	
P	.921	.008	

22. Discussion

CHD places a substantial burden on individuals and society alike. In response to the needs of patients with CHD, CR centers, both in China and internationally, have undergone rapid expansion, offering expert guidance for rehabilitation. However, despite this growth, global participation in CR programs remains disappointingly low, with over 80% of patients in the United States failing to enroll in CR.[21] This lack of engagement is particularly concerning given that the majority of CHD patients eventually progress to stage III of CR, indicating a suboptimal commitment to CR. Factors contributing to this lack of commitment among patients may include misconceptions about their condition, limited awareness of CR benefits, or a deficiency in motivation and necessary behavior-changing skills.

Hence, a pressing priority is to devise convenient and effective educational strategies to improve the long-term management of CHD. Numerous clinical trials have already been initiated to bolster adherence and engagement, including tele-rehabilitation programs employing eHealth platforms such as WeChat and online educational resources.[22] In an era abundant with information accessibility, leveraging network technology for CHD health education becomes imperative.

Self-management involves adopting healthy behavior to mitigate the impact of a disease on one’s well-being by making positive lifestyle changes.[23] CHD, being a chronic ailment intertwined with daily life, often proves resistant to conventional medical treatments. Hence, patients with CHD require ongoing care, with the improvement of their suboptimal lifestyles hinging on enhanced self-management skills. Those excelling in self-management can effectively reduce the recurrence of coronary issues, thereby significantly lowering readmission rates.[24] Factors contributing to inadequate self-management include a lack of motivation, limited knowledge, and impaired cognition.[25] Therefore, interventions aimed at addressing these factors are crucial for enhancing self-management among patients with CHD. To tackle these challenges, we utilized an online teaching platform to provide informative texts and instructional videos on CR, granting patients convenient and continuous access to resources. This approach aims to enhance patients’ understanding of CR, with instructional videos particularly helpful in aiding patients to master exercise rehabilitation techniques and ongoing training. For issues requiring personalized attention beyond online resources, face-to-face guidance was employed to invigorate motivation, increase patient enthusiasm for CR participation, and integrate motivation with self-management behaviors, ultimately improving self-management skills.

The results reveal a significant enhancement in self-management behavior within the experimental group post-intervention compared to the control group. The significance of secondary prevention for CHD lies in preventing disease recurrence, alleviating symptoms, and improving overall quality of life.[26] Adherence to the prescribed secondary prophylaxis regimen recommended by physicians can effectively delay disease progression, manage symptoms, and enhance quality of life.[27] However, it is concerning that a substantial proportion (20–30%) of patients with CHD discontinue their medications prematurely, with poor medication adherence closely linked to increased rates of morbidity and mortality among such patients.[28]

In this study, an online education platform served as a valuable tool for providing patients with essential information regarding common medications, proper administration techniques, and effective behavioral strategies. Patients experiencing difficulties in adhering to their medication regimen were offered the opportunity to engage in private chats with researchers via WeChat, allowing them to discuss the reasons behind their lapses and receive personalized guidance on enhancing medication adherence. For individuals still encountering challenges in understanding and implementing these strategies, face-to-face communication in offline settings provided researchers with insights into their specific hurdles. This approach enabled researchers to offer motivation and support, facilitating the integration of motivation with medication compliance and ultimately leading to improved adherence to prescribed treatments.

Persistent feelings of anxiety and depression among patients can contribute to the development of coronary artery issues such as ischemia, stenosis, and spasms, exacerbating the heart’s insufficient blood supply and leading to the onset of CHD.[29] It is notable that a considerable proportion of CHD patients experience anxiety and depression, along with related challenges in emotional management.[30,31] Thus, patients with CHD are at an elevated risk of suffering from these mental health conditions.

In this study, various educational methods were employed, including platforms like WeChat and in-person communication, to emphasize the detrimental effects of negative emotions, explore their underlying causes, offer support, enhance confidence, and impart techniques for alleviating negative emotional states. The findings indicate that the experimental group demonstrated significantly greater improvements in anxiety and depression compared to the control group.

23. Study limitations

While this study yields valuable insights, it is essential to acknowledge its limitations. Primarily, participant selection from a nearby secondary hospital introduced a degree of selection bias. Moreover, the study was constrained to individuals adept in smartphone usage, thereby excluding those lacking proficiency in smartphone operation from reaping the benefits of the intervention.

24. Conclusion

One year after discharge, the use of an online teaching platform for blended education clearly outperforms the traditional WeChat-based method in CR education for patients with CHD. This enhanced approach not only holds greater efficacy in augmenting patients’ self-management abilities but also demonstrates remarkable potential in alleviating symptoms of anxiety and depression.

Acknowledgments

We would like to acknowledge the hard and dedicated work of all the staff who implemented the intervention and evaluation components of the study.

Author contributions

Conceptualization: Li-Chao Ma, Juan Liu, Cui-Liu Jiao, Yan Wang.

Data curation: Li-Chao Ma, Cui-Liu Jiao, Shao-Ying Du, Ruo-Lan Zhang, Xiao-Juan Ding, Xiao-Yang Shi, Yan Wang.

Formal analysis: Juan Liu, Shao-Ying Du, Ruo-Lan Zhang, Xiao-Yang Shi.

Investigation: Xiao-Juan Ding.

Methodology: Cui-Liu Jiao, Xiao-Juan Ding, Yan Wang.

Resources: Shao-Ying Du.

Visualization: Ruo-Lan Zhang.

Writing – original draft: Li-Chao Ma, Juan Liu, Xiao-Yang Shi, Yan Wang.

Writing – review & editing: Li-Chao Ma, Juan Liu, Cui-Liu Jiao, Xiao-Yang Shi, Yan Wang.

Abbreviations:

CHD coronary heart disease

CR cardiac rehabilitation

Science and Technology Program of Hebei (No. 18277735D).

Written informed consent was obtained from all participants.

This study was conducted with approval from the Ethics Committee of the Affiliated Hospital of Hebei University (No: HDFYLL-KY-2023-130). This study was conducted in accordance with the declaration of Helsinki.

The authors declare that they have no competing interests.

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

How to cite this article: Ma L-C, Liu J, Jiao C-L, Du S-Y, Zhang R-L, Ding X-J, Shi X-Y, Wang Y. Exploring the effects of an online learning platform in stage III cardiac rehabilitation for individuals with coronary heart disease: Randomized controlled study. Medicine 2024;103:37(e39497).

L-CM and JL contributed equally to this study.
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