Skip to main content Skip to main navigation menu Skip to site footer
Articles
VIEWS: 4
Published: 2026-07-30

REHCARDICARE: A Digital Telerehabilitation Platform for Cardiac Recovery Following a Coronary Artery Bypass Graft

Nursing Profession, Audi Indonesia University, North Sumatra, Indonesia
Gita Matura Abadi Kisaran Nursing Academy, North Sumatra, Indonesia
cardiac output cardiac rehabilitation application coronary artery bypass grafting flexibility training resistance training

Abstract

Post-coronary artery bypass graft (CABG) patients often experience decreased cardiac output, which slows recovery and increases the risk of cardiovascular complications. This research and development study evaluated the preliminary effectiveness of the REHCARDICARE application in increasing cardiac output, a key indicator of successful cardiac rehabilitation. The research also assessed user satisfaction to determine the feasibility of broader implementation. The findings can inform further development of the application. The application development used the (Analysis, Design, Development, Implementation, Evaluation) ADDIE model. The study subjects consisted of 30 post-CABG patients purposively selected at the North Sumatra Integrated Heart Center. An application-based resistance and flexibility training intervention was implemented for eight weeks. Data collection and analysis took place two weeks after the intervention was completed. Using a single-group pretest–posttest design, transthoracic Doppler echocardiography was used to measure cardiac output before and after the intervention. Data analysis involved a paired t-test with a significance level of p < 0.05. Cardiac output significantly increased from 4.12 ± 0.55 L/min to 5.28 ± 0.62 L/min (p = 0.001). The feasibility evaluation showed high user satisfaction (87.5 ± 6.8), indicating that REHCARDICARE was perceived as useful and easy to use, with good patient adherence and no significant safety events. Overall, REHCARDICARE demonstrated improved cardiac output after eight weeks and good user acceptance as a digital cardiac rehabilitation tool for post-CABG patients. It is recommended that this application be structurally integrated into the hospital’s cardiac rehabilitation program, that remote monitoring features, and that further tests be conducted using an experimental design with a control group and a larger sample to strengthen the evidence of clinical effectiveness.

References

  1. Avila, A., Claes, J., Buys, R., Azzawi, M., Vanhees, L., & Cornelissen, V. (2020). Home-based exercise with telemonitoring guidance in patients with coronary artery disease: Does it improve long-term physical fitness? European Journal of Preventive Cardiology, 27 (4), 367–377. doi: 10.1177/2047487319892201.
  2. Bachar, B.J., & Manna, B. (2025). Coronary artery bypass graft. StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK507836/.
  3. Danduboyina, A., Panjiyar, B.K., Borra, S.R., & Panicker, S.S. (2023). Cardiovascular benefits of resistance training in patients with heart failure with reduced ejection fraction: A systematic review. Cureus, 15 (10), e47813. doi: 10.7759/cureus.47813.
  4. Dwiputra, B., Santoso, A., Purwowiyoto, B.S., Radi, B., Ambari, A.M., Desandri, D.R., Fatrin, S., & Pandhita, B.A.W. (2023). Smartphone-based cardiac rehabilitation program improves functional capacity in coronary heart disease patients: A systematic review and meta-analysis. Global Heart, 18 (1), 42. doi: 10.5334/gh.1253.
  5. Fahriza, M., & Siregar, Y.F. (2024). Karakteristik pasien penyakit jantung koroner yang menjalani bedah pintas arteri koroner di Medan 2022 [Characteristics of coronary heart disease patients undergoing coronary artery bypass surgery in Medan in 2022]. SCRIPTA SCORE Scientific Medical Journal, 5 (2), 113–120. doi: 10.32734/scripta.v5i2.15013.
  6. Fisher, S., Smart, N.A., & Pearson, M.J. (2022). Resistance training in heart failure patients: A systematic review and meta-analysis. Heart Failure Reviews, 27, 1665–1682. doi: 10.1007/s10741-021-10169-8.
  7. Gallagher, R., Roach, K., Sadler, L., Glinatsis, H., Belshaw, J., Kirkness, A., Zhang, L., Gallagher, P., Paull, G., Gao, Y., Partridge, S.R., Parker, H., & Neubeck, L. (2017). Mobile technology use across age groups in patients eligible for cardiac rehabilitation: Survey study. JMIR Mhealth Uhealth, 5 (10), e161. doi: 10.2196/mhealth.8352.
  8. Harbi, A.S., Soh, K.L., Yubbu, P.B., & Soh, K.G. (2024). Digital health intervention in patients undergoing cardiac rehabilitation: Systematic review and meta-analysis. F1000Research, 13, 596. doi: 10.12688/f1000research.152315.1.
  9. Harik, L., Perezgrovas-Olaria, R., Soletti, G.J., Dimagli, A., Alzghari, T., An, K.R., Cancelli, G., & Gaudino, M. (2023). Sex differences in coronary artery bypass graft surgery outcomes: A narrative review. Journal of Thoracic Disease, 15 (9), 5041–5054. doi: 10.21037/jtd-23-294.
  10. Isath, A., Koziol, K.J., Martinez, M.W., Garber, C.E., Martinez, M.N., Emery, M.S., Baggish, A.L., Naidu, S.S., Lavie, C.J., Arena, R., & Krittanawong, C. (2023). Exercise and cardiovascular health: A state-of-the-art review. Progress in Cardiovascular Diseases, 79, 44–52. doi: 10.1016/j.pcad.2023.04.008.
  11. Ivana, D., & Tjahjono, C.T. (2022). Cardiac rehabilitation to prevent rehospitalization in myocardial infarction patients. Clinical and Research Journal in Internal Medicine, 3 (2), 324–331. doi: 10.21776/ub.crjim.2022.003.02.6.
  12. Kambic, T., Šarabon, N., Lainscak, M., & Hadžić, V. (2022). Combined resistance training with aerobic training improves physical performance in patients with coronary artery disease: A secondary analysis of a randomized controlled clinical trial. Frontiers in Cardiovascular Medicine, 9, 909385. doi: 10.3389/fcvm.2022.909385.
  13. Khattab, O., & Aljeesh, Y. (2024). Health-related quality of life among post myocardial infarction patients. Nursing and Health Sciences Journal (NHSJ), 4 (1), 10–21. doi: 10.53713/nhsj.v4i1.214.
  14. Kim, A.R., Nam, T.-W., Oh, H.-M., Park, E., Huh, J.-W., Yang, W.-J., Yang, D.H., Park, H.S., Lee, Y.-S., & Jung, T. (2018). Effect of hospital-based cardiac rehabilitation on quality of life and physical capacity in acute myocardial infarction patients: 2 years follow up. Journal of Clinical & Experimental Cardiology, 9 (2), 1000573. doi: 10.4172/2155-9880.1000573.
  15. Kim, Y.M., Ryun, K.B., Bom, P.S., Seung, J.J., Jung, K.H., & Sung, S.H. (2025). Feasibility and safety of early cardiac rehabilitation using remote electrocardiogram monitoring in patients with cardiac surgery: A pilot study. Journal of Clinical Medicine, 14 (14), 4887. doi: 10.3390/jcm14144887.
  16. Koike, A., Sobue, Y., Kawai, M., Yamamoto, M., Banno, Y., Harada, M., Kiyono, K., & Watanabe, E. (2022). Safety and feasibility of a telemonitoring-guided exercise program in patients receiving cardiac resynchronization therapy. Annals of Noninvasive Electrocardiology, 27 (2), e12926. doi: 10.1111/anec.12926.
  17. Lee, K.C.S., Breznen, B., Ukhova, A., Koehler, F., & Martin, S.S. (2023). Virtual healthcare solutions for cardiac rehabilitation: A literature review. European Heart Journal - Digital Health, 4 (2), 99–111. doi: 10.1093/ehjdh/ztad005.
  18. Maddison, R., Rawstorn, J.C., Stewart, R.A.H., Benatar, J., Whittaker, R., Rolleston, A., Jiang, Y., Gao, L., Moodie, M., Warren, I., Meads, A., & Gant, N. (2019). Effects and costs of real-time cardiac telerehabilitation: Randomized controlled non-inferiority trial. Heart, 105 (2), 122–129. doi: 10.1136/heartjnl-2018-313189.
  19. Menezes, H.J., D’Souza, S.R.B., Padmakumar, R., Babu, A.S., Rao, R.R., Garg, M., Kotebagilu, N.P., Kamath, V.G., Kamath, A., Satyamurthy, A., Sahu, S., & Grace, S.L. (2025). Technology-based cardiac rehabilitation therapy (TaCT) for women: Intervention implementability, usability, engagement and acceptability in a middle‐income setting. Journal of Education and Health Promotion, 14 (1), 287. doi: 10.4103/jehp.jehp_2200_24.
  20. Ministry of Health of the Republic of Indonesia. (2023). Survei Kesehatan Indonesia (SKI) dalam angka 2023 [Indonesian Health Survey (SKI) 2023 in numbers. Retrieved from https://www.badankebijakan.kemkes.go.id/en/ski-2023-dalam-angka/.
  21. Ministry of Health of the Republic of Indonesia. (2024). A healthy generation, a great future. Retrieved from: https://www.badankebijakan.kemkes.go.id/en/penguatan-transformasi-kesehatan-untuk-generasi-sehat-masa-depan-hebat/.
  22. Muliyawati, A., & Herawati, T. (2024). Home-based cardiac rehabilitation phase II telemonitoring efforts in patients with post-cardiovascular revascularization: Literature review. Nursing Image Journal, 12 (1), 60–70. doi: 10.31964/jck.v12i1.343.
  23. Priatama, M.R., Santoso, A.P., & Ambari, A.M. (2024). Improvement of functional capacity and quality of life by cardiac rehabilitation: Case series. Asian Journal of Healthy and Science, 2 (9), 216–226. doi: 10.58631/ajhs.v3i9.125.
  24. Puri, S.N., & Lalwani, L. (2023). A comparison between cardiac telerehabilitation program and outpatient hospital-based cardiac rehabilitation program for patients undergoing coronary artery bypass graft (CABG) surgery: A review. Cureus, 15 (11), e48488. doi: 10.7759/cureus.48488.
  25. Rawstorn, J.C., Ball, K., Oldenburg, B., Chow, C.K., McNaughton, S.A., Lamb, K.E., Gao, L., Moodie, M., Amerena, J., Nadurata, V., Neil, C., Cameron, S., & Maddison, R. (2020). Smartphone cardiac rehabilitation assisted self-management versus usual care: Protocol for a multicenter randomized controlled trial to compare effects and costs among people with coronary heart disease. JMIR Research Protocols, 9 (1), e15022. doi: 10.2196/15022.
  26. Sharma, A., Sharma, N., Vats, S., Jain, M., Chahal, A., Kashoo, F.Z., Hakamy, A., Alajam, R.A., Alshehri, M.M., Kumar, M.B., Sanjeevi, R.R., Alwadaani, F., & Shaphe, M.A. (2022). Effect of resistance training on body composition, hemodynamic parameters and exercise tolerance among patients with coronary artery disease: A Systematic review. Healthcare (Basel), 11 (1), 131. doi: 10.3390/healthcare11010131.
  27. Tessler, J., Ahmed, I., & Bordoni, B. (2025). Cardiac rehabilitation. In StatPearls. StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK537196/.
  28. Wongvibulsin, S., Habeos, E.E., Huynh, P.P., Xun, H., Shan, R., Rodriguez, K.A.P., Wang, J., Gandapur, Y. K., Osuji, N., Shah, L.M., Spaulding, E.M., Hung, G., Knowles, K., Yang, W.E., Marvel, F.A., Levin, E., Maron, D.J., Gordon, N.F., & Martin, S.S. (2021). Digital health interventions for cardiac rehabilitation: Systematic literature review. Journal of Medical Internet Research, 23 (2), e18773. doi: 10.2196/18773.
  29. Zhang, R., Lan, X., Huang, P., Zhang, Y., Zhu, C., Tian, F., Chen, S., & Chen, Y. (2025). Exercise rehabilitation for patients undergoing interventional treatment for heart valve disease: A scoping review and evidence summary. BMC Nursing, 24, 950. doi: 10.1186/s12912-025-03603-x.

How to Cite

Sinaga, E., & Batubara, K. (2026). REHCARDICARE: A Digital Telerehabilitation Platform for Cardiac Recovery Following a Coronary Artery Bypass Graft. Jurnal Keperawatan Indonesia, 29(2), 202–211. https://doi.org/10.7454/jki.v29i2.1928