The National Institute for Health and Care Excellence (NICE) has conditionally approved seven digital technologies to support cardiac rehabilitation for adults with cardiovascular disease (CVD).

The final draft guidance states that these platforms can be used in the NHS in England for a 3-year trial period. The approval will allow patients to undergo cardiac rehabilitation at home using smartphones, tablets, or computers. NICE said the approach could improve access for people who struggle to attend face-to-face programmes.

The approved technologies — Activate Your Heart, D REACH-HF, Digital Heart Manual, Gro Health HeartBuddy, KiActiv, myHeart, and Pumping Marvellous Cardiac Rehab Platform  — will be used during a data collection period to address uncertainties about their long-term effectiveness. The platforms offer a range of services, including structured exercise programmes, CVD education, dietary guidance, medication support, and psychological care. Some also integrate wearable devices to track activity levels.

The NICE committee noted that evidence for the clinical benefits of digital cardiac rehabilitation remains limited. However, existing data suggest these technologies can improve exercise capacity, cardiovascular risk factors, and health-related quality of life compared with conventional programmes. Digital platforms may also offer meaningful clinical benefits for people with CVD, particularly those who have limited access to traditional rehabilitation services.

Addressing Low Participation Rates 

The decision comes amid persistently low participation rates in traditional cardiac rehabilitation programmes. In 2023, only 41% of eligible people with acute coronary syndrome and 13% of those with heart failure in England participated in cardiac rehabilitation programmes. Digital platforms could provide support to communities where participation remains low, particularly among women, younger people, ethnic minorities, those in deprived areas, and those who struggle to attend face-to-face sessions.

Anastasia Chalkidou, NICE’s HealthTech programme director, said that the platforms “offer real potential to transform how cardiac rehabilitation is offered to people to meet their individual circumstances.” She added that “early data is promising and suggests, with safeguards in place, more people should now be given the opportunity to use these new technologies.”

Clinical Evidence

Evidence shows that several platforms can reduce the risk for secondary cardiovascular events. Activate Your Heart has been assessed in three studies, including two randomised control trials (RCTs); Gro Health HeartBuddy in one study; KiActiv in two studies (one RCT); and myHeart in two studies (one RCT). 

However, clinical outcome definitions varied, and studies included a maximum follow-up of 6 months, making long-term effectiveness uncertain.

Implementation and Economics

A trained NHS professional must assess each patient before offering these technologies. They may be used only once this assessment is completed, evidence is being generated as required, and all regulatory approvals are in place.

An economic model developed by the External Assessment Group found all digital platforms to be cost-saving compared with conventional rehabilitation, with small quality-of-life gains where supporting clinical evidence existed. Savings mainly arose from reduced delivery costs between initial and final in-person sessions.

Companies must secure evidence-generation agreements and provide annual progress updates to NICE. After the 3-year period, they must submit the collected evidence for NICE’s decision on routine NHS use.

Future Outlook

Younger patients with CVD may prefer digital tools that support independence whilst maintaining healthcare professional support. People with work or caregiving responsibilities — especially women — are less likely to attend in-person rehab. Digital tools could help reduce inequalities in participation and adherence by age and sex.

However, they may present challenges for certain populations including older people, those with dexterity issues, individuals lacking regular access to smart devices or internet, non-English speakers, and people experiencing homelessness. NICE noted that targeted support may be needed to avoid widening existing inequalities.

Five other digital technologies — Beat Better, Datos Health, Get Ready, Luscii vitals, and R Plus Health — require more research before they can be funded by the NHS and should only be used in research settings. NICE may revise or withdraw the guidance if evidence-generation conditions are not met during the 3-year period.