From Cath Lab to Cloud: A Scoping Review on Telehealth and Remote Monitoring in Post-PCI Patient

From Cath Lab to Cloud: A Scoping Review on Telehealth and Remote Monitoring in Post-PCI Patient | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review From Cath Lab to Cloud: A Scoping Review on Telehealth and Remote Monitoring in Post-PCI Patient Aninka Saboe, Muhammad Arga Putra Saboe, Avinindita Nura Lestari This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6768890/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Percutaneous coronary intervention (PCI) is a cornerstone treatment for patients with coronary artery disease, but optimal recovery requires comprehensive secondary prevention strategies. Despite strong guideline recommendations, participation in conventional cardiac rehabilitation (CR) remains low due to logistical, socioeconomic, and accessibility barriers. The growing integration of telehealth, mobile health (mHealth), and remote monitoring technologies offers new opportunities to improve post-PCI care delivery, adherence, and outcomes. Objective : This scoping review aimed to map and synthesize existing research on the use of telehealth and remote monitoring interventions for patients following PCI, with a focus on implementation strategies, clinical outcomes, and patient engagement. Methods : Following the Joanna Briggs Institute (JBI) scoping review methodology, we conducted a structured search of PubMed and Google Scholar for English-language, peer-reviewed original research articles published between January 2020 and April 2025. Eligible studies involved human patients post-PCI and evaluated telehealth, telemedicine, or remote monitoring interventions. Review articles, protocols, non-English papers, and studies unrelated to PCI or telehealth were excluded. Screening and data extraction were independently performed by multiple reviewers. Results : From 191 initially identified records, 12 studies met the inclusion criteria. Interventions included mHealth applications, hybrid CR programs, wearable devices, structured teleconsultations, and remote disease management platforms. Reported outcomes included improvements in CR participation, medication adherence, physical activity, quality of life, and psychological well-being. Several studies demonstrated noninferiority of home-based or hybrid CR to traditional center-based models. Platforms incorporating interactive education, live coaching, or biometric feedback were particularly effective in sustaining patient engagement. However, heterogeneity in study design, short-term follow-up, and limited reporting of hard clinical endpoints remain common limitations. Conclusion : Telehealth and remote monitoring interventions show strong potential to enhance post-PCI care by addressing barriers to traditional rehabilitation and enabling personalized, accessible follow-up. Although findings are promising, future research should focus on long-term outcomes, scalability, and cost-effectiveness to inform broader integration into cardiovascular care models. telehealth cardiac rehabilitation percutaneous coronary intervention Figures Figure 1 Introduction Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, with coronary artery disease (CAD) and acute coronary syndromes (ACS) contributing significantly to global health and economic burden. 1 Percutaneous coronary intervention (PCI) is a cornerstone treatment for patients with obstructive coronary lesions, offering rapid symptom relief and improved outcomes. However, long-term success relies heavily on comprehensive secondary prevention strategies, including lifestyle modification, medication adherence, and ongoing cardiovascular risk factor management. 2 , 3 Cardiac rehabilitation (CR) is a guideline-recommended intervention shown to reduce recurrent cardiovascular events, improve functional capacity, and enhance quality of life. 4 Despite its benefits, participation in conventional center-based CR remains suboptimal due to barriers such as travel distance, time constraints, socioeconomic disparities, and limited access in rural areas. 5 , 6 This underutilization has prompted the evolution of alternative models, including home-based and telehealth-supported cardiac rehabilitation (teleCR). The integration of telehealth and mobile health (mHealth) technologies into post-PCI care offers a scalable and patient-centered approach to address these barriers. 7 , 8 Various digital interventions—such as mobile apps, wearable devices, remote coaching, and virtual education—have emerged to support patient engagement, monitor clinical status, and reinforce self-management behavior remotely. 9 Early evidence suggests that these approaches may be as effective as conventional rehabilitation programs in improving clinical outcomes, adherence, and satisfaction. 10 , 11 However, clinical implementations of telehealth in post-PCI patients remain heterogeneous in design, target populations, and reported outcomes. Therefore, a comprehensive mapping of recent studies is warranted to better understand the scope, characteristics, and effectiveness of telehealth and remote monitoring interventions in this population. This scoping review aims to explore and synthesize the current evidence on the use of telehealth and remote monitoring technologies in post-PCI patients, with a particular focus on clinical implementations, outcome measures, and patient engagement strategies. Methods Review of the literature We Conducted a scoping review according to a predefined protocol based on the following five-stage approach developed by the Joanna Briggs Institute (JBI): Stage 1, identifying the research question; Stage 2, identifying relevant studies; Stage 3, study selections; Stage 4, charting the data; and Stage 5 collating, summarizing and reporting the results. 12 Eligibility Criteria To guide study inclusion, we followed the Joanna Briggs Institute (JBI) Population–Concept–Context (PCC) framework, adapted to the focus of this scoping review on telehealth and remote monitoring interventions in patients following percutaneous coronary intervention (PCI). Population : We included studies involving human patients of any age who had undergone percutaneous coronary intervention (PCI) for any indication, including acute coronary syndrome (ACS) or chronic coronary syndrome (CCS). Both inpatient and outpatient populations were eligible, provided the study focused on the post-procedural period. Concept : Eligible studies implemented telehealth, telemedicine, or remote monitoring interventions as part of post-PCI care. This included, but was not limited to, mobile health (mHealth) applications designed to support self-management; wearable devices used to monitor vital signs or physical activity remotely; virtual coaching sessions or teleconsultations with healthcare providers; home-based or hybrid cardiac rehabilitation programs that combined in-person and digital components; and digital platforms that facilitated patient education, routine follow-up, or medication adherence through remote access. Context : We considered studies conducted in any healthcare or community setting, including hospitals, rehabilitation centers, outpatient clinics, or home-based environments. To be eligible, studies had to be original research articles—such as randomized controlled trials, cohort studies, feasibility trials, or implementation studies—published in English between January 2020 and April 2025, reflecting the most recent developments in digital and remote care delivery during and after the COVID-19 pandemic. Exclusion Criteria We excluded studies if they met any of the following criteria: Studies that did not involve patients who had undergone percutaneous coronary intervention (PCI). Interventions that did not include any telehealth, telemedicine, or remote monitoring component. Studies focusing solely on in-hospital monitoring without a post-discharge or follow-up element. Studies evaluating digital tools unrelated to structured follow-up or cardiac rehabilitation. Editorials, commentaries, letters to the editor, or protocols without reported outcome data. Conference abstracts without access to full-text articles. Non-English language publications. Studies involving other cardiac procedures (e.g., coronary artery bypass grafting, valve interventions) without a specific focus on post-PCI care. Data Extraction and Synthesis A structured literature search was conducted across PubMed and Google Scholar to identify relevant peer-reviewed studies published between January 2020 and April 2025. The search strategy combined Medical Subject Headings (MeSH) and keyword-based terms using Boolean operators to capture studies investigating the use of telehealth, telemedicine, or remote monitoring interventions in post-percutaneous coronary intervention (post-PCI) patients. Google Scholar was searched using aligned combinations of free-text keywords, and results were manually screened. Only English-language, full-text original research articles were considered. All identified citations were imported into Mendeley for organization and duplicate removal. Two reviewers independently screened the titles and abstracts. Full texts of potentially eligible studies were reviewed in detail, and any disagreements regarding inclusion were resolved through discussion. A third reviewer provided methodological oversight. Results Summary of publications Our initial search across PubMed and Google Scholar identified a total of 191 articles published between January 2020 and April 2025. Of these, 18 articles were excluded for being review articles, 97 were excluded for not focusing on patients undergoing percutaneous coronary intervention (PCI), and 5 were excluded for not being published in English. The remaining 71 articles were assessed in full text, of which 59 were excluded for not incorporating any telehealth, telemedicine, or remote monitoring component. Ultimately, 12 studies met all inclusion criteria and were included in the final scoping review. Findings from Included Studies: Telehealth and Remote Monitoring in Post-PCI Patients The 12 studies included in this scoping review demonstrated a variety of telehealth, mobile health (mHealth), and remote monitoring interventions aimed at improving outcomes in patients following percutaneous coronary intervention (PCI). Interventions were delivered through smartphone applications, wearable devices, web-based platforms, and hybrid telerehabilitation programs, targeting domains such as cardiac rehabilitation (CR) participation, physical activity promotion, medication adherence, and psychological support. Several studies focused on mobile applications with live coaching or educational content. Yamashita et al. evaluated a smartphone-based application integrated with live health coaching and found improvements in medication adherence and quality of life compared to standard care. 2 Similarly, Cruz-Cobo et al. tested the eMOTIVA app, which featured gamified education modules and self-monitoring tools, and reported superior adherence to dietary and lifestyle recommendations as well as higher satisfaction and usability scores. 9 Hybrid or home-based cardiac rehabilitation was another common theme. Mattioli et al. compared hybrid CR (center-based plus synchronous telerehabilitation) with standard CR, demonstrating noninferior outcomes in exercise capacity, strength, and functional measures. 4 Pini's thesis at the University of Bern further confirmed that teleCR was as effective as traditional CR in improving cardiovascular risk factors such as LDL cholesterol and exercise tolerance, and was especially preferred by younger, tech-literate patients. 11 Wearable technologies were used to remotely monitor physical activity, blood pressure, and heart rate. Sato et al. implemented an intervention using accelerometer-equipped wearables and found that online feedback significantly influenced self-care behavior and renal function preservation in ACS patients post-PCI. 13 Similarly, Lindman et al. reported the feasibility and safety of exercise-based cardiac telerehabilitation supported by remote exercise tracking in a multicenter real-world setting. 10 Communication-based platforms such as WeChat were also used for remote care coordination. Li et al. demonstrated that structured health management through WeChat significantly improved quality of life and blood pressure control among post-PCI patients. 8 Meanwhile, the hospital-community-family “trinity” rehabilitation model studied by Wang et al. integrated digital follow-up, local clinic support, and family involvement, improving both cardiac function and rehabilitation adherence. 3 Studies assessing remote monitoring systems also emphasized emotional well-being and patient empowerment. Zhang et al. found that internet-based telerehabilitation led to higher compliance rates, better left ventricular function, and improved depression and anxiety scores compared to conventional care. 7 Additionally, Chen et al. applied a chronic disease intelligent information platform and found it enhanced self-care behaviors and health literacy. 14 Collectively, these studies show that telehealth and remote monitoring approaches are diverse in design but generally effective in improving clinical, behavioral, and psychosocial outcomes following PCI. They also highlight the potential of digital tools to address long-standing barriers to cardiac rehabilitation such as geographic distance, resource limitations, and patient disengagement. Discussion This scoping review demonstrates the growing potential of telehealth, mobile health (mHealth), and remote monitoring interventions to enhance recovery and secondary prevention in patients following percutaneous coronary intervention (PCI). The 12 included studies suggest that digitally enabled strategies—ranging from smartphone applications to wearable-assisted home-based rehabilitation—can improve clinical, behavioral, and psychosocial outcomes by extending care beyond hospital settings and overcoming traditional barriers to cardiac rehabilitation (CR) participation. One of the most prominent trends is the use of mHealth applications to support patient self-management. The eMOTIVA app, for instance, combined structured education with gamification and showed improvements in dietary adherence, physical activity, and cardiovascular risk factor knowledge compared to standard care. 9 Similarly, Yamashita et al. found that a smartphone-based intervention with live coaching improved medication adherence and overall quality of life. 2 These findings underscore the importance of real-time feedback and interactive features in sustaining patient engagement. Studies exploring hybrid and home-based CR models further reinforce the feasibility and effectiveness of remote rehabilitation delivery. A randomized trial by Mattioli et al. showed that hybrid CR combining center-based and telerehabilitation sessions produced outcomes comparable to traditional CR in terms of exercise capacity and strength. 4 Pini's thesis added that teleCR participants showed significant improvements in cardiovascular risk markers and favored the flexible, home-based format, especially among younger patients. 11 Wearable technologies also featured prominently across studies. Sato et al. used accelerometer-equipped wearables integrated with online coaching to help preserve renal function and promote physical activity in ACS patients post-PCI. 13 The SWEDEHEART study demonstrated the safety and acceptability of remotely supervised exercise training using wearable monitoring, confirming the value of digital tools in supporting unsupervised rehabilitation. 10 Communication platforms, especially those adapted to local contexts, proved useful in bridging gaps in access and follow-up. A structured WeChat-based intervention significantly improved health-related quality of life and blood pressure control, emphasizing the utility of culturally familiar technology. 8 In another model, the hospital–community–family “trinity” program improved both cardiac function and CR participation by coordinating care across settings with digital support. 3 Beyond physical recovery, several interventions positively impacted psychosocial outcomes. Zhang et al. reported reductions in anxiety and depression along with improved left ventricular function among patients receiving internet-based telerehabilitation. 7 Similarly, Chen et al. found that an intelligent chronic disease management platform enhanced self-care confidence and health literacy 14 , pointing to the added value of telehealth in empowering patients. Despite promising results, the included studies varied in design, population, and outcome measures. Most focused on short-term follow-up, and there is limited data on long-term adherence, cardiovascular event reduction, or cost-effectiveness. Additionally, many studies were single-center or pilot in nature, limiting generalizability. Future research should focus on larger, multicenter trials with standardized outcome reporting and inclusion of hard clinical endpoints to further evaluate the scalability and long-term impact of these interventions. Table 1 Summary of Included Studies - Telehealth and Remote Monitoring in Post-PCI Patients Study Technology Intervention Application Type Outcome Summary Zhang et al. (2023) Remote rehab app Internet-based telerehab CR adherence, LV function Telehealth Improved LV function, reduced anxiety Wang et al. (2023) Trinity rehab model Hospital-community-family integration Cardiac rehab participation Telehealth + Community Improved LVEF and adherence Mattioli et al. (2022) Hybrid CR sessions Hybrid cardiac rehab Functional capacity, strength Hybrid Noninferior to center-based CR Sato et al. (2025) Wearable device Remote PA feedback Renal function, activity level Wearable + Web-based Preserved eGFR, increased steps Cruz-Cobo et al. (2023) eMOTIVA app Gamified mHealth app Lifestyle, knowledge, satisfaction mHealth Improved diet, PA, satisfaction Yamashita et al. (2022) Smartphone app Live health coaching Medication adherence, QoL mHealth + Coaching Improved adherence, QoL Pini (2024) TeleCR program Home-based rehab vs center LDL, exercise capacity TeleCR Equivalent to center-based CR Lindman et al. (2024) Exercise tracking Multicenter telerehab Feasibility, engagement Wearable/Tracking Feasible, well-received Li et al. (2022) WeChat app Structured health management QoL, BP control Messaging-based Improved QoL, BP Chen et al. (2023) Chronic disease platform Digital disease management Self-care behavior Web-based platform Improved self-care literacy Pini (2024) TeleCR Remote hybrid delivery Risk factor control Hybrid model Preferred by younger patients Chen et al. (2023) Chronic disease platform Digital disease management Self-care behavior Web-based platform Improved self-care literacy Study Limitation This scoping review has several limitations that should be acknowledged. First, although a structured and comprehensive search was conducted across PubMed and Google Scholar, the inclusion was limited to English-language articles, which may have introduced language bias and excluded relevant studies published in other languages. Second, the heterogeneity of study designs, interventions, outcome measures, and populations limited our ability to perform comparative analysis or meta-synthesis. The included studies varied widely in terms of intervention type (e.g., mHealth apps, wearables, hybrid CR models), follow-up duration, and reported outcomes, making it difficult to generalize findings across settings. Third, many of the included studies were small-scale, single-center trials or feasibility studies with short-term follow-up. Longitudinal outcomes, such as sustained behavior change, major adverse cardiovascular events (MACE), and cost-effectiveness, were seldom addressed. This limits the ability to draw conclusions about the long-term clinical impact and scalability of these interventions. Last, although patient-reported outcomes such as satisfaction, engagement, and quality of life were commonly reported, few studies used standardized instruments or blinded assessments, which may affect the reliability of those results.. Conclusion This scoping review highlights the expanding role of telehealth, mobile health applications, wearable devices, and hybrid rehabilitation models in the post-PCI setting. The 12 included studies demonstrate that such interventions can enhance cardiac rehabilitation participation, improve medication adherence, promote self-care, and positively impact both physical and psychological outcomes. These digital approaches show promise in overcoming longstanding barriers to secondary prevention, including geographical constraints, limited access to facilities, and patient disengagement. While the evidence supports their short-term feasibility and effectiveness, further research is needed to establish long-term clinical impact, cost-effectiveness, and integration into routine care. As healthcare systems increasingly adopt digital tools, telehealth has the potential to become a cornerstone of personalized, accessible, and sustainable cardiovascular care for PCI patients. Abbreviations ACS – Acute Coronary Syndrome BP – Blood Pressure CAD – Coronary Artery Disease CCS – Chronic Coronary Syndrome CR – Cardiac Rehabilitation CVD – Cardiovascular Disease eGFR – Estimated Glomerular Filtration Rate JBI – Joanna Briggs Institute LDL – Low-Density Lipoprotein LV – Left Ventricle / Left Ventricular LVEF – Left Ventricular Ejection Fraction mHealth – Mobile Health MACE – Major Adverse Cardiovascular Events PCI – Percutaneous Coronary Intervention QoL – Quality of Life TeleCR – Telehealth-supported Cardiac Rehabilitation Declarations Human Ethics and Consent to Participate Not applicable. This study is a scoping review of previously published literature and did not involve human participants. Consent to Participate Not applicable. No new data were collected from human subjects. Ethics Approval Not applicable. This review is based solely on publicly available research articles. Author Contribution AS led the study design, conducted the literature search, and drafted the manuscript. MAPS contributed to data analysis, interpretation, and manuscript revision. ANL assisted with data collection and critically reviewed the manuscript. All authors read and approved the final manuscript. References Li S, Zhang Y, Wang J, et al. The cardiovascular disease landscape in China: a health systems perspective. In: Cardiovascular Disease: Global Perspectives . Springer; 2023. p. 217–239. Yamashita Y, Aoyama S, Sugimura M, et al. Outcomes of a smartphone-based application with live health-coaching post-percutaneous coronary intervention. ESC Heart Fail. 2022;9(6):3917–3925. Wang Y, Wang Q, He L, et al. Effects of the hospital-community-family trinity cardiac rehabilitation on patients with acute myocardial infarction after percutaneous coronary intervention: a randomized trial. Front Cardiovasc Med. 2023;10:1132177. Mattioli AV, Sciomer S, Moscucci F, et al. Comparison between hybrid cardiac rehabilitation and standard care: a randomized controlled study. Eur J Prev Cardiol. 2022;29(7):1115–1122. Quenard F, Lecoffre E, Gabet A, et al. Socio-geographical factors associated with cardiac rehabilitation participation: a mixed-methods study in rural France. Eur J Prev Cardiol. 2024;31(5):853–861. Fruytier L, Serban IB, Van de Sande DAJP, et al. Exploring the needs and preferences of athletes in cardiac (tele)rehabilitation to enhance rehabilitation outcome: a qualitative study. Patient Prefer Adherence. 2025;19:685–698. Zhang Y, Zhao J, Sun J. Internet-based telerehabilitation guidance brings additional benefits to patients after percutaneous coronary intervention. Heart Surg Forum. 2023;26(6):E926–E933. Li X, Wang H, Liu Y, et al. Remote health management via WeChat to improve quality of life post-percutaneous coronary intervention. Int J Med Inform. 2022;158:104624. Cruz-Cobo C, Bernal-Jiménez MA, Calle-Pérez G, et al. Efficacy of an mHealth application (eMOTIVA) in compliance with cardiac rehabilitation guidelines in patients with coronary artery disease: a randomized controlled clinical trial. JMIR Preprints. 2023 Dec 13. https://doi.org/10.2196/preprints.55421 Lindman C, Sandberg G, Carlsson J, et al. Feasibility, safety and patient perceptions of exercise-based cardiac telerehabilitation in a multicentre real-world setting after myocardial infarction: the remote exercise SWEDEHEART study. Eur J Prev Cardiol. 2024;31(2):241–249. Pini M. Comparison between center-based cardiac rehabilitation and home-based telerehabilitation regarding short-term health outcomes. Bern (Switzerland): University of Bern; 2024. Joanna Briggs Institute. The Joanna Briggs Institute reviewers' manual 2015: methodology for JBI scoping reviews [Internet]. 2015 [cited May 21, 2025]. Available from: https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Scoping-.pdf Sato T, Suzuki D, Sasamoto Y, et al. Impact of online support of physical activity management using a wearable device on renal function in patients with acute coronary syndrome: a randomized controlled trial protocol. PeerJ. 2025;13:e19067. Chen J, Lu M, Wang W, et al. Study on the management effect of chronic disease intelligent information management platform in post-percutaneous coronary intervention patients. J Healthc Eng. 2023;2023:8837745. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6768890","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":464037205,"identity":"b642d6fd-cb4d-4d3e-9b24-7154e38ee04c","order_by":0,"name":"Aninka Saboe","email":"","orcid":"","institution":"Dr. Hasan Sadikin General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Aninka","middleName":"","lastName":"Saboe","suffix":""},{"id":464037206,"identity":"ca32e999-1227-42ba-9d29-6ca24c7bf5d9","order_by":1,"name":"Muhammad Arga Putra Saboe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYFACHijN3gAkDCxI0cJzAKRFghQtEglgkrAG+fazBx98qLln1z/z+dUNPwokGPjbuxPwajE4k5dsOONYcfKM2zllN3uADpM4c3YDfi0MOWbSPGwJyQy3c9Ju8AC1GEjk4tci3//GTPrPv4Rk+Ztn0m7+IUYLww2gLYxtCXYGN9iP3SbKFoMb75INe/sSEgzP5LDdljGQ4CHoF/n+3IMPfnxLsJc7fvzZzTd/bOT423sJOAwKEhsYeAxADB5CKuHAHphiHhCtehSMglEwCkYWAABjgkmN4Ye2PgAAAABJRU5ErkJggg==","orcid":"","institution":"Cibabat General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Muhammad","middleName":"Arga Putra","lastName":"Saboe","suffix":""},{"id":464037207,"identity":"5e3cea27-5e35-475b-a3d3-2ece736fe1ed","order_by":2,"name":"Avinindita Nura Lestari","email":"","orcid":"","institution":"Mahar Mardjono National Brain Center Hospital","correspondingAuthor":false,"prefix":"","firstName":"Avinindita","middleName":"Nura","lastName":"Lestari","suffix":""}],"badges":[],"createdAt":"2025-05-28 14:08:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6768890/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6768890/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83913439,"identity":"69be8f38-4838-4941-88ee-8ed6b9794841","added_by":"auto","created_at":"2025-06-04 12:22:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":146428,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram summarizing the study selection process\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6768890/v1/dc9220d02e95bf0762b2dcd1.png"},{"id":84510714,"identity":"cea52b34-8cc7-4e2b-89d2-d0ef02cd627e","added_by":"auto","created_at":"2025-06-12 21:16:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":666213,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6768890/v1/48c01a29-809c-4376-847b-c1c52e2357c9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"From Cath Lab to Cloud: A Scoping Review on Telehealth and Remote Monitoring in Post-PCI Patient","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, with coronary artery disease (CAD) and acute coronary syndromes (ACS) contributing significantly to global health and economic burden.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Percutaneous coronary intervention (PCI) is a cornerstone treatment for patients with obstructive coronary lesions, offering rapid symptom relief and improved outcomes. However, long-term success relies heavily on comprehensive secondary prevention strategies, including lifestyle modification, medication adherence, and ongoing cardiovascular risk factor management.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCardiac rehabilitation (CR) is a guideline-recommended intervention shown to reduce recurrent cardiovascular events, improve functional capacity, and enhance quality of life.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Despite its benefits, participation in conventional center-based CR remains suboptimal due to barriers such as travel distance, time constraints, socioeconomic disparities, and limited access in rural areas.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e This underutilization has prompted the evolution of alternative models, including home-based and telehealth-supported cardiac rehabilitation (teleCR).\u003c/p\u003e \u003cp\u003eThe integration of telehealth and mobile health (mHealth) technologies into post-PCI care offers a scalable and patient-centered approach to address these barriers.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Various digital interventions\u0026mdash;such as mobile apps, wearable devices, remote coaching, and virtual education\u0026mdash;have emerged to support patient engagement, monitor clinical status, and reinforce self-management behavior remotely.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Early evidence suggests that these approaches may be as effective as conventional rehabilitation programs in improving clinical outcomes, adherence, and satisfaction.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHowever, clinical implementations of telehealth in post-PCI patients remain heterogeneous in design, target populations, and reported outcomes. Therefore, a comprehensive mapping of recent studies is warranted to better understand the scope, characteristics, and effectiveness of telehealth and remote monitoring interventions in this population. This scoping review aims to explore and synthesize the current evidence on the use of telehealth and remote monitoring technologies in post-PCI patients, with a particular focus on clinical implementations, outcome measures, and patient engagement strategies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eReview of the literature\u003c/h2\u003e \u003cp\u003eWe Conducted a scoping review according to a predefined protocol based on the following five-stage approach developed by the Joanna Briggs Institute (JBI): Stage 1, identifying the research question; Stage 2, identifying relevant studies; Stage 3, study selections; Stage 4, charting the data; and Stage 5 collating, summarizing and reporting the results.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEligibility Criteria\u003c/h3\u003e\n\u003cp\u003e To guide study inclusion, we followed the Joanna Briggs Institute (JBI) Population\u0026ndash;Concept\u0026ndash;Context (PCC) framework, adapted to the focus of this scoping review on telehealth and remote monitoring interventions in patients following percutaneous coronary intervention (PCI).\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePopulation\u003c/b\u003e: We included studies involving human patients of any age who had undergone percutaneous coronary intervention (PCI) for any indication, including acute coronary syndrome (ACS) or chronic coronary syndrome (CCS). Both inpatient and outpatient populations were eligible, provided the study focused on the post-procedural period.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eConcept\u003c/b\u003e: Eligible studies implemented telehealth, telemedicine, or remote monitoring interventions as part of post-PCI care. This included, but was not limited to, mobile health (mHealth) applications designed to support self-management; wearable devices used to monitor vital signs or physical activity remotely; virtual coaching sessions or teleconsultations with healthcare providers; home-based or hybrid cardiac rehabilitation programs that combined in-person and digital components; and digital platforms that facilitated patient education, routine follow-up, or medication adherence through remote access.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eContext\u003c/b\u003e: We considered studies conducted in any healthcare or community setting, including hospitals, rehabilitation centers, outpatient clinics, or home-based environments. To be eligible, studies had to be original research articles\u0026mdash;such as randomized controlled trials, cohort studies, feasibility trials, or implementation studies\u0026mdash;published in English between January 2020 and April 2025, reflecting the most recent developments in digital and remote care delivery during and after the COVID-19 pandemic.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003eWe excluded studies if they met any of the following criteria:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStudies that did not involve patients who had undergone percutaneous coronary intervention (PCI).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eInterventions that did not include any telehealth, telemedicine, or remote monitoring component.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies focusing solely on in-hospital monitoring without a post-discharge or follow-up element.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies evaluating digital tools unrelated to structured follow-up or cardiac rehabilitation.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEditorials, commentaries, letters to the editor, or protocols without reported outcome data.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eConference abstracts without access to full-text articles.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNon-English language publications.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies involving other cardiac procedures (e.g., coronary artery bypass grafting, valve interventions) without a specific focus on post-PCI care.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eData Extraction and Synthesis\u003c/h3\u003e\n\u003cp\u003eA structured literature search was conducted across PubMed and Google Scholar to identify relevant peer-reviewed studies published between January 2020 and April 2025. The search strategy combined Medical Subject Headings (MeSH) and keyword-based terms using Boolean operators to capture studies investigating the use of telehealth, telemedicine, or remote monitoring interventions in post-percutaneous coronary intervention (post-PCI) patients. Google Scholar was searched using aligned combinations of free-text keywords, and results were manually screened. Only English-language, full-text original research articles were considered. All identified citations were imported into Mendeley for organization and duplicate removal. Two reviewers independently screened the titles and abstracts. Full texts of potentially eligible studies were reviewed in detail, and any disagreements regarding inclusion were resolved through discussion. A third reviewer provided methodological oversight.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSummary of publications\u003c/h2\u003e \u003cp\u003eOur initial search across PubMed and Google Scholar identified a total of 191 articles published between January 2020 and April 2025. Of these, 18 articles were excluded for being review articles, 97 were excluded for not focusing on patients undergoing percutaneous coronary intervention (PCI), and 5 were excluded for not being published in English. The remaining 71 articles were assessed in full text, of which 59 were excluded for not incorporating any telehealth, telemedicine, or remote monitoring component. Ultimately, 12 studies met all inclusion criteria and were included in the final scoping review.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFindings from Included Studies: Telehealth and Remote Monitoring in Post-PCI Patients\u003c/h3\u003e\n\u003cp\u003eThe 12 studies included in this scoping review demonstrated a variety of telehealth, mobile health (mHealth), and remote monitoring interventions aimed at improving outcomes in patients following percutaneous coronary intervention (PCI). Interventions were delivered through smartphone applications, wearable devices, web-based platforms, and hybrid telerehabilitation programs, targeting domains such as cardiac rehabilitation (CR) participation, physical activity promotion, medication adherence, and psychological support.\u003c/p\u003e \u003cp\u003eSeveral studies focused on mobile applications with live coaching or educational content. Yamashita et al. evaluated a smartphone-based application integrated with live health coaching and found improvements in medication adherence and quality of life compared to standard care.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Similarly, Cruz-Cobo et al. tested the eMOTIVA app, which featured gamified education modules and self-monitoring tools, and reported superior adherence to dietary and lifestyle recommendations as well as higher satisfaction and usability scores.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHybrid or home-based cardiac rehabilitation was another common theme. Mattioli et al. compared hybrid CR (center-based plus synchronous telerehabilitation) with standard CR, demonstrating noninferior outcomes in exercise capacity, strength, and functional measures.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Pini's thesis at the University of Bern further confirmed that teleCR was as effective as traditional CR in improving cardiovascular risk factors such as LDL cholesterol and exercise tolerance, and was especially preferred by younger, tech-literate patients.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWearable technologies were used to remotely monitor physical activity, blood pressure, and heart rate. Sato et al. implemented an intervention using accelerometer-equipped wearables and found that online feedback significantly influenced self-care behavior and renal function preservation in ACS patients post-PCI.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Similarly, Lindman et al. reported the feasibility and safety of exercise-based cardiac telerehabilitation supported by remote exercise tracking in a multicenter real-world setting.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCommunication-based platforms such as WeChat were also used for remote care coordination. Li et al. demonstrated that structured health management through WeChat significantly improved quality of life and blood pressure control among post-PCI patients.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Meanwhile, the hospital-community-family \u0026ldquo;trinity\u0026rdquo; rehabilitation model studied by Wang et al. integrated digital follow-up, local clinic support, and family involvement, improving both cardiac function and rehabilitation adherence.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eStudies assessing remote monitoring systems also emphasized emotional well-being and patient empowerment. Zhang et al. found that internet-based telerehabilitation led to higher compliance rates, better left ventricular function, and improved depression and anxiety scores compared to conventional care.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Additionally, Chen et al. applied a chronic disease intelligent information platform and found it enhanced self-care behaviors and health literacy.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCollectively, these studies show that telehealth and remote monitoring approaches are diverse in design but generally effective in improving clinical, behavioral, and psychosocial outcomes following PCI. They also highlight the potential of digital tools to address long-standing barriers to cardiac rehabilitation such as geographic distance, resource limitations, and patient disengagement.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis scoping review demonstrates the growing potential of telehealth, mobile health (mHealth), and remote monitoring interventions to enhance recovery and secondary prevention in patients following percutaneous coronary intervention (PCI). The 12 included studies suggest that digitally enabled strategies\u0026mdash;ranging from smartphone applications to wearable-assisted home-based rehabilitation\u0026mdash;can improve clinical, behavioral, and psychosocial outcomes by extending care beyond hospital settings and overcoming traditional barriers to cardiac rehabilitation (CR) participation.\u003c/p\u003e \u003cp\u003eOne of the most prominent trends is the use of mHealth applications to support patient self-management. The eMOTIVA app, for instance, combined structured education with gamification and showed improvements in dietary adherence, physical activity, and cardiovascular risk factor knowledge compared to standard care.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Similarly, Yamashita et al. found that a smartphone-based intervention with live coaching improved medication adherence and overall quality of life.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e These findings underscore the importance of real-time feedback and interactive features in sustaining patient engagement.\u003c/p\u003e \u003cp\u003eStudies exploring hybrid and home-based CR models further reinforce the feasibility and effectiveness of remote rehabilitation delivery. A randomized trial by Mattioli et al. showed that hybrid CR combining center-based and telerehabilitation sessions produced outcomes comparable to traditional CR in terms of exercise capacity and strength.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Pini's thesis added that teleCR participants showed significant improvements in cardiovascular risk markers and favored the flexible, home-based format, especially among younger patients.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWearable technologies also featured prominently across studies. Sato et al. used accelerometer-equipped wearables integrated with online coaching to help preserve renal function and promote physical activity in ACS patients post-PCI.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e The SWEDEHEART study demonstrated the safety and acceptability of remotely supervised exercise training using wearable monitoring, confirming the value of digital tools in supporting unsupervised rehabilitation.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e Communication platforms, especially those adapted to local contexts, proved useful in bridging gaps in access and follow-up. A structured WeChat-based intervention significantly improved health-related quality of life and blood pressure control, emphasizing the utility of culturally familiar technology.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e In another model, the hospital\u0026ndash;community\u0026ndash;family \u0026ldquo;trinity\u0026rdquo; program improved both cardiac function and CR participation by coordinating care across settings with digital support.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eBeyond physical recovery, several interventions positively impacted psychosocial outcomes. Zhang et al. reported reductions in anxiety and depression along with improved left ventricular function among patients receiving internet-based telerehabilitation.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Similarly, Chen et al. found that an intelligent chronic disease management platform enhanced self-care confidence and health literacy\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, pointing to the added value of telehealth in empowering patients.\u003c/p\u003e \u003cp\u003eDespite promising results, the included studies varied in design, population, and outcome measures. Most focused on short-term follow-up, and there is limited data on long-term adherence, cardiovascular event reduction, or cost-effectiveness. Additionally, many studies were single-center or pilot in nature, limiting generalizability. Future research should focus on larger, multicenter trials with standardized outcome reporting and inclusion of hard clinical endpoints to further evaluate the scalability and long-term impact of these interventions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of Included Studies - Telehealth and Remote Monitoring in Post-PCI Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTechnology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eApplication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eType\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOutcome Summary\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZhang et al. (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRemote rehab app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInternet-based telerehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCR adherence, LV function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTelehealth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eImproved LV function, reduced anxiety\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWang et al. (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrinity rehab model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHospital-community-family integration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCardiac rehab participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTelehealth\u0026thinsp;+\u0026thinsp;Community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eImproved LVEF and adherence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMattioli et al. (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHybrid CR sessions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHybrid cardiac rehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFunctional capacity, strength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHybrid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNoninferior to center-based CR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSato et al. (2025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWearable device\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRemote PA feedback\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRenal function, activity level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWearable\u0026thinsp;+\u0026thinsp;Web-based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePreserved eGFR, increased steps\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCruz-Cobo et al. (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eeMOTIVA app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGamified mHealth app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLifestyle, knowledge, satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003emHealth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eImproved diet, PA, satisfaction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYamashita et al. (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmartphone app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLive health coaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedication adherence, QoL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003emHealth\u0026thinsp;+\u0026thinsp;Coaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eImproved adherence, QoL\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePini (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeleCR program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHome-based rehab vs center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLDL, exercise capacity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTeleCR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEquivalent to center-based CR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLindman et al. (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExercise tracking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMulticenter telerehab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFeasibility, engagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWearable/Tracking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFeasible, well-received\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLi et al. (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeChat app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStructured health management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQoL, BP control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMessaging-based\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eImproved QoL, BP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChen et al. (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic disease platform\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDigital disease management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSelf-care behavior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWeb-based platform\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eImproved self-care literacy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePini (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeleCR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRemote hybrid delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRisk factor control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHybrid model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePreferred by younger patients\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChen et al. (2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic disease platform\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDigital disease management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSelf-care behavior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWeb-based platform\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eImproved self-care literacy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitation\u003c/h2\u003e \u003cp\u003eThis scoping review has several limitations that should be acknowledged. First, although a structured and comprehensive search was conducted across PubMed and Google Scholar, the inclusion was limited to English-language articles, which may have introduced language bias and excluded relevant studies published in other languages. Second, the heterogeneity of study designs, interventions, outcome measures, and populations limited our ability to perform comparative analysis or meta-synthesis. The included studies varied widely in terms of intervention type (e.g., mHealth apps, wearables, hybrid CR models), follow-up duration, and reported outcomes, making it difficult to generalize findings across settings.\u003c/p\u003e \u003cp\u003eThird, many of the included studies were small-scale, single-center trials or feasibility studies with short-term follow-up. Longitudinal outcomes, such as sustained behavior change, major adverse cardiovascular events (MACE), and cost-effectiveness, were seldom addressed. This limits the ability to draw conclusions about the long-term clinical impact and scalability of these interventions. Last, although patient-reported outcomes such as satisfaction, engagement, and quality of life were commonly reported, few studies used standardized instruments or blinded assessments, which may affect the reliability of those results..\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis scoping review highlights the expanding role of telehealth, mobile health applications, wearable devices, and hybrid rehabilitation models in the post-PCI setting. The 12 included studies demonstrate that such interventions can enhance cardiac rehabilitation participation, improve medication adherence, promote self-care, and positively impact both physical and psychological outcomes. These digital approaches show promise in overcoming longstanding barriers to secondary prevention, including geographical constraints, limited access to facilities, and patient disengagement. While the evidence supports their short-term feasibility and effectiveness, further research is needed to establish long-term clinical impact, cost-effectiveness, and integration into routine care. As healthcare systems increasingly adopt digital tools, telehealth has the potential to become a cornerstone of personalized, accessible, and sustainable cardiovascular care for PCI patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eACS \u0026ndash; Acute Coronary Syndrome\u003c/li\u003e\n \u003cli\u003eBP \u0026ndash; Blood Pressure\u003c/li\u003e\n \u003cli\u003eCAD \u0026ndash; Coronary Artery Disease\u003c/li\u003e\n \u003cli\u003eCCS \u0026ndash; Chronic Coronary Syndrome\u003c/li\u003e\n \u003cli\u003eCR \u0026ndash; Cardiac Rehabilitation\u003c/li\u003e\n \u003cli\u003eCVD \u0026ndash; Cardiovascular Disease\u003c/li\u003e\n \u003cli\u003eeGFR \u0026ndash; Estimated Glomerular Filtration Rate\u003c/li\u003e\n \u003cli\u003eJBI \u0026ndash; Joanna Briggs Institute\u003c/li\u003e\n \u003cli\u003eLDL \u0026ndash; Low-Density Lipoprotein\u003c/li\u003e\n \u003cli\u003eLV \u0026ndash; Left Ventricle / Left Ventricular\u003c/li\u003e\n \u003cli\u003eLVEF \u0026ndash; Left Ventricular Ejection Fraction\u003c/li\u003e\n \u003cli\u003emHealth \u0026ndash; Mobile Health\u003c/li\u003e\n \u003cli\u003eMACE \u0026ndash; Major Adverse Cardiovascular Events\u003c/li\u003e\n \u003cli\u003ePCI \u0026ndash; Percutaneous Coronary Intervention\u003c/li\u003e\n \u003cli\u003eQoL \u0026ndash; Quality of Life\u003c/li\u003e\n \u003cli\u003eTeleCR \u0026ndash; Telehealth-supported Cardiac Rehabilitation\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cb\u003eHuman Ethics and Consent to Participate\u003c/b\u003e \u003c/p\u003e \u003cp\u003eNot applicable. This study is a scoping review of previously published literature and did not involve human participants.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to Participate\u003c/strong\u003e \u003cp\u003eNot applicable. No new data were collected from human subjects.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics Approval\u003c/strong\u003e \u003cp\u003eNot applicable. This review is based solely on publicly available research articles.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAS led the study design, conducted the literature search, and drafted the manuscript. MAPS contributed to data analysis, interpretation, and manuscript revision. ANL assisted with data collection and critically reviewed the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLi S, Zhang Y, Wang J, et al. The cardiovascular disease landscape in China: a health systems perspective. In: \u003cem\u003eCardiovascular Disease: Global Perspectives\u003c/em\u003e. Springer; 2023. p. 217\u0026ndash;239.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYamashita Y, Aoyama S, Sugimura M, et al. Outcomes of a smartphone-based application with live health-coaching post-percutaneous coronary intervention. \u003cem\u003eESC Heart Fail.\u003c/em\u003e 2022;9(6):3917\u0026ndash;3925.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Wang Q, He L, et al. Effects of the hospital-community-family trinity cardiac rehabilitation on patients with acute myocardial infarction after percutaneous coronary intervention: a randomized trial. \u003cem\u003eFront Cardiovasc Med.\u003c/em\u003e 2023;10:1132177.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMattioli AV, Sciomer S, Moscucci F, et al. Comparison between hybrid cardiac rehabilitation and standard care: a randomized controlled study. \u003cem\u003eEur J Prev Cardiol.\u003c/em\u003e 2022;29(7):1115\u0026ndash;1122.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuenard F, Lecoffre E, Gabet A, et al. Socio-geographical factors associated with cardiac rehabilitation participation: a mixed-methods study in rural France. \u003cem\u003eEur J Prev Cardiol.\u003c/em\u003e 2024;31(5):853\u0026ndash;861.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFruytier L, Serban IB, Van de Sande DAJP, et al. Exploring the needs and preferences of athletes in cardiac (tele)rehabilitation to enhance rehabilitation outcome: a qualitative study. \u003cem\u003ePatient Prefer Adherence.\u003c/em\u003e 2025;19:685\u0026ndash;698.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Zhao J, Sun J. Internet-based telerehabilitation guidance brings additional benefits to patients after percutaneous coronary intervention. \u003cem\u003eHeart Surg Forum.\u003c/em\u003e 2023;26(6):E926\u0026ndash;E933.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi X, Wang H, Liu Y, et al. Remote health management via WeChat to improve quality of life post-percutaneous coronary intervention. \u003cem\u003eInt J Med Inform.\u003c/em\u003e 2022;158:104624.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCruz-Cobo C, Bernal-Jim\u0026eacute;nez MA, Calle-P\u0026eacute;rez G, et al. Efficacy of an mHealth application (eMOTIVA) in compliance with cardiac rehabilitation guidelines in patients with coronary artery disease: a randomized controlled clinical trial. \u003cem\u003eJMIR Preprints.\u003c/em\u003e 2023 Dec 13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/preprints.55421\u003c/span\u003e\u003cspan address=\"10.2196/preprints.55421\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLindman C, Sandberg G, Carlsson J, et al. Feasibility, safety and patient perceptions of exercise-based cardiac telerehabilitation in a multicentre real-world setting after myocardial infarction: the remote exercise SWEDEHEART study. \u003cem\u003eEur J Prev Cardiol.\u003c/em\u003e 2024;31(2):241\u0026ndash;249.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePini M. Comparison between center-based cardiac rehabilitation and home-based telerehabilitation regarding short-term health outcomes. Bern (Switzerland): University of Bern; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoanna Briggs Institute. \u003cem\u003eThe Joanna Briggs Institute reviewers' manual 2015: methodology for JBI scoping reviews\u003c/em\u003e [Internet]. 2015 [cited May 21, 2025]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Scoping-.pdf\u003c/span\u003e\u003cspan address=\"https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Scoping-.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSato T, Suzuki D, Sasamoto Y, et al. Impact of online support of physical activity management using a wearable device on renal function in patients with acute coronary syndrome: a randomized controlled trial protocol. \u003cem\u003ePeerJ.\u003c/em\u003e 2025;13:e19067.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen J, Lu M, Wang W, et al. Study on the management effect of chronic disease intelligent information management platform in post-percutaneous coronary intervention patients. \u003cem\u003eJ Healthc Eng.\u003c/em\u003e 2023;2023:8837745.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"telehealth, cardiac rehabilitation, percutaneous coronary intervention","lastPublishedDoi":"10.21203/rs.3.rs-6768890/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6768890/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Percutaneous coronary intervention (PCI) is a cornerstone treatment for patients with coronary artery disease, but optimal recovery requires comprehensive secondary prevention strategies. Despite strong guideline recommendations, participation in conventional cardiac rehabilitation (CR) remains low due to logistical, socioeconomic, and accessibility barriers. The growing integration of telehealth, mobile health (mHealth), and remote monitoring technologies offers new opportunities to improve post-PCI care delivery, adherence, and outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: This scoping review aimed to map and synthesize existing research on the use of telehealth and remote monitoring interventions for patients following PCI, with a focus on implementation strategies, clinical outcomes, and patient engagement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Following the Joanna Briggs Institute (JBI) scoping review methodology, we conducted a structured search of PubMed and Google Scholar for English-language, peer-reviewed original research articles published between January 2020 and April 2025. Eligible studies involved human patients post-PCI and evaluated telehealth, telemedicine, or remote monitoring interventions. Review articles, protocols, non-English papers, and studies unrelated to PCI or telehealth were excluded. Screening and data extraction were independently performed by multiple reviewers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: From 191 initially identified records, 12 studies met the inclusion criteria. Interventions included mHealth applications, hybrid CR programs, wearable devices, structured teleconsultations, and remote disease management platforms. Reported outcomes included improvements in CR participation, medication adherence, physical activity, quality of life, and psychological well-being. Several studies demonstrated noninferiority of home-based or hybrid CR to traditional center-based models. Platforms incorporating interactive education, live coaching, or biometric feedback were particularly effective in sustaining patient engagement. However, heterogeneity in study design, short-term follow-up, and limited reporting of hard clinical endpoints remain common limitations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Telehealth and remote monitoring interventions show strong potential to enhance post-PCI care by addressing barriers to traditional rehabilitation and enabling personalized, accessible follow-up. Although findings are promising, future research should focus on long-term outcomes, scalability, and cost-effectiveness to inform broader integration into cardiovascular care models.\u003c/p\u003e","manuscriptTitle":"From Cath Lab to Cloud: A Scoping Review on Telehealth and Remote Monitoring in Post-PCI Patient","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-04 12:22:18","doi":"10.21203/rs.3.rs-6768890/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9a9c07bd-5734-47d3-987e-2caf62bfea26","owner":[],"postedDate":"June 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-12T21:08:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-04 12:22:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6768890","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6768890","identity":"rs-6768890","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}