AI&DHI Innovation Spotlight: VALENTINE After Phase II Cardiac Rehabilitation
This edition of the AI&DHI Innovation Spotlight focuses on a study led by Dr. Jessica Golbus, Assistant Professor in the Division of Cardiovascular Medicine.
In 2020, Dr. Golbus and her team set out to examine whether a mobile health (mHealth) intervention using personalized text message guidance could improve the physical activity levels of low and moderate risk patients who were enrolled in center-based cardiac rehabilitation (CR)—a secondary prevention program for patients with cardiovascular disease that includes physical activity and exercise training.
The team enrolled over 220 participants in a randomized control trial and provided them with either an Apple Watch or Fitbit smartwatch to augment their ongoing CR care. The intervention group also received contextually-tailored text messages as just-in-time interventions. The main goal of the study was to see if these interventions improved the distance that participants could walk in six minutes after six months.
Study Results
Ultimately, the study revealed no significant improvement in participants’ walking distance at six months for either smartwatch group. While Dr. Golbus’s team noticed some improvements in walk distance for Fitbit users at three months or for Apple users when adjusting for baseline factors of participants, they found no significant change in step counts over the duration of the study. Overall, the team concluded that the mHealth interventions did not enhance long-term outcomes for CR patients, though results also suggest there may have been benefits for certain users.
According to Dr. Golbus, one of the most interesting aspects of the study was its application of micro randomization and just-in-time adaptive messages, which provided the team with insights into the impact of text messages as well as the times of day and environments in which these messages were effective.
Another unique aspect of the study was that, due to the then-ongoing COVID-19 pandemic, it was conducted fully remotely. This allowed the team to enroll patients from CR centers that included both an academic medical center and a large community-based health system. This resulted in a diverse set of participants, with over 20% recruited from a community medical center that served patients living in more rural areas.
While the VALENTINE study officially concluded in 2023, the team has been conducting additional analyses of the data in subsequent publications. The scalable study model has enabled the team to apply the same technology and experimental design to multiple other studies including an American Heart Association (AHA)-funded trial led by Dr. Brahmajee Nallamothu called “myBPmyLife,” and an NIH-funded K23 led by Dr. Golbus.
“I was in the third year of my cardiology fellowship when I first started the VALENTINE study. Now, I spend a large portion of my time thinking about how we can use digital technologies to support and extend the benefits of cardiac rehabilitation. I believe this, in large part, was due to the opportunities afforded by this grant.”
Jessica Golbus, MD, MS
Assistant Professor, Internal Medicine, Division of Cardiovascular Medicine
How AI&DHI Empowered this Work
AI & Digital Health Innovation was one of three sources to provide initial funding support for this work, together with MCubed and the Frankel Cardiovascular Center’s Aikens Innovation Academy. AI&DHI also provided server space for Dr. Golbus and her team as well as secure data support through its Research Data Warehouse (RDW).
According to Dr. Golbus, this support was impactful not only because it helped establish the infrastructure needed to conduct further fully remote digital health studies like this, but it also jump-started Dr. Golbus’s career in digital health research.
“The AI&DHI grant funded a project in cardiac rehabilitation, which was a novel area for me at the time but is now one of my primary areas of focus,” said Dr. Golbus. “I was in the third year of my cardiology fellowship when I first started the VALENTINE study. Now, I spend a large portion of my time thinking about how we can use digital technologies to support and extend the benefits of cardiac rehabilitation. I believe this, in large part, was due to the opportunities afforded by this grant.”
Main Study Publication
Additional Publications
About AI & Digital Health Innovation
AI & Digital Health Innovation (formerly Precision Health at U-M) is dedicated to empowering researchers at the University Michigan to change the future of digital healthcare. They work with multi-disciplinary teams of health providers, basic scientists, engineers, and administrators to tackle the most difficult research problems and help rapidly bring ideas to the bedside. For more information visit aidhi.umich.edu.