Application of Digital Health Technologies in Cardiac Rehabilitation for Patients With Coronary Heart Disease: Scoping Review

Introduction

Background

The World Health Organization’s (WHO) report on the world’s top 10 causes of death indicates that cardiovascular disease (CVD) claims the highest number of lives, with coronary heart disease (CHD) accounting for 13% of global mortality [1]. Beyond the health burden, CVD, particularly CHD, imposes a significant economic strain. Globally, CHD accounts for 42% of total CVD expenditure, with annual per capita expenditure on CHD reaching 4.9% to 137.8% of per capita gross domestic product [2]. This underscores how CHD has become a “heavy burden” weighing upon individuals, families, society, and health care systems. More notably, despite substantial investment, the overall prognosis for patients with CHD has yet to improve effectively.

In response to this challenge, cardiac rehabilitation (CR) has demonstrated significant value as a comprehensive intervention. Research indicates that CR can reduce cardiovascular adverse events by 28%, 1-year readmission rates by 31%, and mortality by 24% while effectively reducing health care expenditure [3-5]. It is recommended as a class Ia evidence-based intervention in clinical guidelines [6,7]. However, participation rates in CR programs remain universally low among patients with CHD globally [8-10]. Rates range from 9.7% to 22.5% in Germany, 20% to 30% in the United States, and a mere 41.5% in the United Kingdom [8-10]. Asian nations present similarly unfavorable figures: Singapore at 12.3% and Japan and South Korea between 14% and 50% [4,11-13]. As the most populous developing nation, China has CR centers constituting merely 0.06% of all medical institutions, with underdeveloped regions accounting for a mere 8.8% [14]. Beyond awareness factors, limitations inherent to traditional CR, such as transport difficulties, time conflicts, and uneven resource distribution, constitute primary barriers to participation [15].

At this intersection of practical need and technological innovation, digital health technologies (DHTs) have transcended the constraints of conventional CR, forging novel pathways for its implementation [16]. In 2019, the WHO formally introduced the concept of DHTs, defining them as the field of developing and using digital technologies to disseminate health knowledge and facilitate related practices [17]. This encompasses applications of technologies such as the Internet of Things and artificial intelligence within health management [17]. Digital devices such as pedometers, accelerometers, and smartphones enable daily activity tracking, exercise intensity assessment, and personalized exercise guidance for patients with CHD [18,19]. Smart pillboxes and “digital pills” facilitate real-time monitoring of medication adherence [20,21]. Thus, DHTs overcome temporal and spatial constraints to deliver more accessible rehabilitation support. They effectively alleviate resource scarcity issues and hold promise for extending benefits to a broader population with CHD [22,23].

In summary, DHTs offer novel solutions to low CR participation rates. However, their highly heterogeneous delivery formats result in fragmented evidence. Compared to traditional review methodologies, scoping reviews can integrate heterogeneous evidence and define research boundaries [24-26]. Therefore, in this study, we use a scoping review approach to systematically collate evidence in this field, providing a holistic perspective for subsequent research and policy formulation. This aims to bridge gaps in cardiovascular health accessibility and advance the scientific, universal, and sustainable development of digital CR.

Objectives and Research Questions

In this study, we aim to systematically review the scope of DHT applications in CR for patients with CHD through a scoping literature review methodology. It seeks to provide evidence-based guidance for the diversified development and effective implementation of future CR.

Our research will clarify (1) the application strategies and scenarios of existing digital technologies in CR for patients with CHD; (2) the key performance indicators determining the effectiveness of current DHT applications, alongside identifying their primary challenges; and (3) how DHTs can be more effectively applied to CR for patients with CHD and future research directions.

Methods

Overview

In this study, we strictly followed the Joanna Briggs Institute’s scoping review methodology framework to ensure methodological rigor and transparency in the research process [27,28]. This scoping review adhered strictly to a structured research process, using standardized methodologies to ensure the reliability of findings and their practical applicability. The research involved comprehensive systematic literature searches, data extraction, and evidence synthesis analysis, culminating in a narrative synthesis of studies concerning the application of DHTs in CR for patients with CHD. As a scoping review, our primary objective is to systematically map the current application, intervention formats, and outcome measures of DHTs in CR for patients with CHD. It does not evaluate intervention effectiveness or evidence quality grades; consequently, no rigorous methodological quality assessment of included studies was conducted [29]. Our review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines [26]. The PRISMA-ScR checklist is provided in Checklist 1.

Eligibility Criteria

The inclusion criteria for this scoping review were based on the Joanna Briggs Institute Scope Review Methodology Guide and structured using the participants, concept, context framework [30]. The inclusion and exclusion criteria are presented in Textbox 1.

Information Sources

We conducted systematic searches of the following 5 electronic databases: PubMed, Web of Science (Clarivate), Embase (Elsevier), Cochrane Library (Wiley), and EBSCO (EBSCOhost). Searches were performed independently within each database interface, without using cross-database simultaneous search functionality.

Search Strategy

The literature search process for this study was reported in accordance with the PRISMA-S (extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews) guidelines [31]. The search strategy was independently developed by the research team based on the databases’ subject term lists, without direct adaptation or use of other published scoping review strategies. The complete search strategies for each database are detailed in Multimedia Appendix 1. The researchers first conducted a preliminary search in the PubMed database to expand the keywords and use MeSH to determine standardized subject terms. Following this, a search strategy was developed, and an initial search was conducted in PubMed, with a brief analysis of the results. Two researchers collaboratively developed the final search strategy, which was reviewed by a third researcher. The PubMed search strategy is detailed in Textbox 2. To maintain sensitivity, no restrictions were applied regarding study design, language, or publication type. The search time frame spanned from the inception of each database to February 2026. Furthermore, as this scoping review aimed to map published evidence to delineate the existing evidence base, clinical trial registries were excluded from the search.

Selection of Sources

The literature retrieval and screening process were independently conducted by 2 researchers trained in evidence-based medicine and possessing cardiovascular research experience, with the entire procedure subject to third-party oversight. The specific workflow was as follows: (1) Search results from all databases were imported into EndNote (Clarivate) reference management software, which automatically identified and excluded duplicate records; (2) 2 researchers independently conducted an initial screening of the remaining literature based on predefined inclusion and exclusion criteria, reviewing titles and abstracts; (3) screening results were cross-checked; discrepancies were resolved through third-party discussion until consensus was reached; and (4) full-text evaluation of initially selected papers determined final inclusion in the study.

Data Charting Process and Items

Data extraction was conducted using predesigned standardized forms by 2 researchers independently using Microsoft Excel to extract content covering the following core elements: (1) basic information: author, year of publication, and country; (2) study design: study type, sample size, follow-up duration, and control group configuration; (3) population characteristics: disease type; (4) intervention details: type of DHT, intervention duration, frequency of use, combination use, and combination method; (5) intervention objective; (6) outcome measures: primary outcomes and secondary outcomes; and (7) key findings: intervention effectiveness. In the event of disagreement during data extraction, a third researcher shall arbitrate the resolution.

Results

Selection of Sources of Evidence

As illustrated in Figure 1, this study strictly adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) process for literature screening [32]. The initial search yielded 8156 publications. After removing 2320 duplicates using EndNote, 2 researchers (XZ and ZL) independently screened titles and abstracts. Based on predefined inclusion criteria, 5836 publications were excluded. The remaining 407 publications underwent full-text assessment, resulting in the exclusion of 364 publications that did not meet the requirements. Ultimately, 43 studies were included in the analysis.

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Characteristics of Sources of Evidence

Figure 2 presents an overview of the 43 included studies by year and geographical distribution. The publication span of the included studies ranges from 2014 to 2026, with a marked increase in relevant research since 2021, with 60.5% of studies published from 2021 to 2026. The geographical coverage spans 18 countries, with China accounting for the highest proportion of studies at 34.9% (15/43) [19,33-46].

Of the 43 studies included in total, the vast majority used randomized controlled designs, comprising 33 randomized controlled trials [33,36,38,39,41,43-69] and 7 randomized controlled pilot studies [34,35,37,42,70-72]. Among the remaining studies, 2 were quasi-randomized controlled trials [40,73], and 1 was a controlled before-and-after study [74]. Detailed characteristics of the studies included in this scoping review are presented in Table 1.

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Results of Individual Sources of Evidence

In this study, we analyzed data from 43 research papers and generated an evidence gap map (Table 2) illustrating the application forms and objectives of DHT interventions.

The Form of DHT in CR for Patients With CHD

The 43 studies included in this research demonstrate that DHTs exhibit significant diversity in their application within CR for patients with CHD. These technologies can be categorized into 3 core groups (Table 3): digital health tools, real-time remote support, and asynchronous communication. Among these, digital health tools represent the most prevalent intervention form, enabling patients with CHD to undertake self-management and monitoring primarily through devices or software. This includes apps (28/43, 65.1%) [34,37,39-41,44-48,50,51,53,54,56-59,61-67,69,72,73], wearable devices (22/43, 51.1%) [19,33,36,39,40,42,45,46,49,52-54,58,61-64,69-72], websites (9/43, 20.9%) [33,35,42,49,55,60,66,72,74], and social media platforms (6/43, 13.9%) [19,34,36,38,43,44]. Wearable devices encompass smartwatches, heart rate monitors, fitness trackers, and pedometers, primarily used for real-time monitoring of physiological indicators and exercise data. Real-time remote support involves direct interpersonal interaction via voice or video, covering telephone (15/43, 34.8%) [19,33,36,38,39,44,49,51,53,57,62,65,67,72,73], remote counseling sessions, and group meetings. Asynchronous communication delivers reminders, education, and support through non–real-time information exchange, chiefly via SMS text messaging (10/43, 23.2%) [43,50-52,65,67,68,70,73] and email. As shown in Table 2, multitechnology combined interventions have become the predominant model. A substantial 83.7% (36/43) of studies used combinations of 2 or more digital technologies, such as “app+wearable device” [39,40,45,46,48,53,54,58,61-64,69,72] and “social media platform+wearable device+telephone” [19,36]. Some studies further integrated digital technologies with traditional rehabilitation methods like face-to-face guidance and offline education, forming blended online-offline rehabilitation models. This landscape not only reflects varying levels of technological support, from standalone tools to interpersonal interactions, but also signals the trend toward systematized and diversified digital CR.

The Objectives of DHT in CR for Patients With CHD

From the perspective of intervention objectives, the application of DHTs in CHD rehabilitation exhibits distinct functional stratification. Health education (36/43, 83.7%) [19,33-40,58-60,65-70,72-74], data monitor (34/43, 79.1%) [19,33-40,45-51,53-58,61-67,69-74], and reminders and alerts (18/43, 41.9%) [19,34,37,38,40,43-45,47,50-52,54,55,71-73] form the core functional layer, each accounting for over 80% of applications in the included studies. Feedback, goal setting, and personalized interventions constitute the secondary core functional layer, with application rates ranging between 50% and 70%. Additionally, some studies integrated distinctive features such as gamification, reward mechanisms, social support, emotional support or counseling, and remotely adjust prescription to address patients’ diverse rehabilitation needs. Building upon this, this study systematically categorized the intervention objectives across 43 publications, identifying 15 specific types grouped into 4 major categories: first, motivation and guidance, encompassing goal setting, feedback, reward mechanisms, gamification, and reminders and alerts, aimed at incentivizing patients with CHD to complete rehabilitation behaviors and enhance adherence; second, foundation of knowledge and skills, centered on health education and training courses to help patients with CHD build the knowledge base and self-management capabilities required for disease management; third, monitoring and security, including data monitoring, real-time monitoring, and ensuring safety for physiological indicator tracking, risk assessment, and safety protection during rehabilitation; and fourth, social and group dynamics, leveraging peer effects and social support mechanisms to use social relationships and group interactions to promote patient adherence to rehabilitation behaviors. The specific composition is detailed in Table 4. As shown in Table 2, health education emerged most frequently, underscoring the central role of knowledge transfer in contemporary digital rehabilitation practice. Notably, the vast majority of studies adopted multipurpose integrated intervention strategies, organically combining educational, motivational, monitoring, and social support functions rather than relying on single technological approaches. It is precisely this composite application model that has transformed DHTs from fragmented tools into systematic rehabilitation support systems, significantly enhancing the holistic nature and continuity of rehabilitation interventions.

Evaluation Criteria of DHT in CR for Patients With CHD

The outcome measures included in the study encompass 5 major categories: clinical physiological indicators, rehabilitation behavioral indicators, patient-reported outcomes, rehabilitation service use rates, and technical feasibility. Clinical physiological indicators include peak oxygen uptake, 6-minute walk distance, and blood pressure. Rehabilitation behavioral indicators include exercise adherence, medication adherence, physical activity levels, dietary adherence, and sedentary time. Patient-reported outcomes encompassed quality of life, self-efficacy, anxiety and depression levels, disease knowledge, and rehabilitation satisfaction. Rehabilitation service use metrics included rehabilitation acceptance rate, adherence rate, completion rate, readmission rate, and emergency department visit rate. Technical feasibility referred to patient satisfaction with the DHT used.

Clinical Efficacy and Physiological Indicators

Clinical efficacy and physiological indicators constitute the core dimensions for evaluating the effectiveness of DHTs, with over 60% of studies incorporating them as primary outcomes. These encompass 3 specific levels: cardiopulmonary function, physical capacity and strength, and clinical end-point events. Cardiopulmonary function stands as the most critical indicator, with peak oxygen uptake [39,42,44,49,58,66,70,71] and 6-minute walk distance [42,49,58,62,63,70,71] being the most widely applied measures. Combining remote monitoring, wearable devices, and online guidance can effectively improve patients’ cardiopulmonary function, as measured by peak oxygen uptake and 6-minute walk distance [49,70]. Physical function and strength serve as supplementary dimensions, encompassing muscle endurance and overall physical capacity. Dalli Peydró et al [63] confirmed that remote rehabilitation improves patients’ physical activity capabilities. Regarding clinical end points, over 20 studies evaluated blood pressure, lipid profiles, N-terminal pro-brain natriuretic peptide, and left ventricular ejection fraction. Li et al [37] found that app-based interventions increased lipid control rates; however, no consistent conclusions have emerged regarding long-term outcomes such as readmission rates and major adverse cardiovascular events. For instance, Krzowski et al [47] did not demonstrate a significant advantage of digital interventions in reducing readmission rates, suggesting that further research is needed to substantiate long-term efficacy.

Health Behavior and Lifestyle

Health behaviors and lifestyle constitute core factors in improving the long-term prognosis of patients with CHD, with over half of the studies incorporating them into evaluations. These are categorized into 2 dimensions: exercise behavior and daily lifestyle. Regarding exercise behavior, key indicators include physical activity levels, exercise adherence, number of exercise days, and duration. Xu et al [41] demonstrated in a telerehabilitation study based on the Self-Monitoring, Coaching, e-Health, Interactive Feedback, and Personalization model that the intervention group exhibited significantly superior exercise adherence and duration compared to the control group. Varnfield et al [48] confirmed that smartphone-based home rehabilitation effectively enhances physical activity levels in patients with postmyocardial infarction. Optimization of daily lifestyle habits has also garnered significant attention, encompassing indicators such as medication adherence, dietary compliance, fruit and vegetable intake, sedentary time, and smoking cessation behavior. Interventions incorporating digital tools have shown positive effects on dietary adherence, sedentary time, and smoking cessation [50,51]. DHTs effectively enhance patient motivation for behavioral change through personalized reminders, real-time feedback, and adaptive goal-setting, thereby promoting the sustained maintenance of healthy behaviors.

Patient-Reported Outcomes and Cognitive Function

Patient-reported outcomes and cognitive-related indicators constitute crucial dimensions for evaluating the humanistic value of DHTs. A total of 34 such indicators were incorporated into the studies as assessment criteria, encompassing domains such as quality of life, social cognition and support, disease knowledge, and psychological state [33-36,38-42,44-51,53,54,56,58-68,70,71,73]. Quality of life emerged as the most frequently assessed outcome, with multiple studies using scales such as the Short Form 36 Health Survey, EQ-5D, and Heart Disease-Specific Quality of Life Questionnaire. Dodson et al [53] demonstrated positive trends in mobile health interventions improving health status among older patients, while Hisam et al [54] found that mobile health interventions significantly enhanced quality of life in patients with postacute coronary syndrome. Regarding knowledge and self-management capabilities, health education emerged as the most prevalent intervention objective. Its efficacy was evaluated through indicators such as cardiovascular risk factor knowledge and self-management competence. Chan et al [34] confirmed that 0-time exercise interventions can enhance patients’ exercise self-efficacy. In the domain of social cognition and support, Duan et al [35] incorporated social cognitive outcomes into its evaluation. DHTs effectively enhance patient cognition through personalized education and interactive feedback, providing crucial support for the long-term maintenance of rehabilitation outcomes.

Program Participation and Adherence

Participation rates and adherence in CR are core indicators for assessing the real-world feasibility of DHTs. These encompass rehabilitation program participation rates, adherence rates, completion rates, alongside patient satisfaction and perceived acceptability. Varnfield et al [48] found that smartphone-based home rehabilitation significantly improved rehabilitation uptake, adherence, and completion rates among patients with postmyocardial infarction compared to conventional rehabilitation, providing robust evidence for digital technologies enhancing rehabilitation engagement. Ramachandran et al [72] further validated the advantages of home-based remote rehabilitation in improving rehabilitation use rates. Patient satisfaction, acceptability, and perceived ease of use of the technology are also crucial evaluation components. Studies by Bernal-Jiménez et al [51] and Cruz-Cobo et al [50] both incorporated application satisfaction into their evaluation frameworks. Multiple studies indicate that DHTs, through their accessibility, convenience, and interactive features, significantly reduce participation barriers such as geographical constraints and time conflicts, laying a solid foundation for improving rehabilitation participation rates and adherence.

Technical Feasibility, Safety, and Use

Against the backdrop of rapid advancements in DHTs, evaluating their feasibility, safety, and impact on health care service use is particularly crucial. Assessments of technical feasibility encompass device operational stability, data collection integrity, and user-friendliness. Wohlfahrt et al [71] demonstrated in their study that smart device step tracking exhibits good feasibility and compliance among patients with postmyocardial infarction. Safety assessments involve adverse event monitoring, data privacy protection, and risk alert mechanisms. Ma et al [40] demonstrated in a long-term follow-up study that digital interventions did not increase the risk of major adverse cardiovascular events. Health care use metrics include readmission rates and emergency department visit rates. Widmer et al [55] observed a downward trend in readmissions and emergency visits within the digital intervention group, though this did not reach statistical significance. Several studies have mentioned the need for cost-effectiveness analysis of digital rehabilitation, and preliminary explorations suggest that it may have potential economic advantages, but more empirical evidence is needed, though further evidence accumulation remains necessary.

Discussion

Principal Findings

In this study, we used a scoping review methodology to systematically evaluate the current application of DHTs in CR for patients with CHD. The research revealed its core characteristics, including diverse forms of technological application, multidimensional intervention objectives, and multilevel assessment indicators. It integrated 3 categories of technological application forms, 4 categories of intervention objectives, and 5 types of outcome assessment indicators. Findings indicate that DHTs have evolved from supplementary aids to systematic solutions, effectively overcoming the temporal and spatial constraints of traditional rehabilitation. This advance has significantly improved patient engagement in CR and treatment adherence in patients with CHD.

Diversity and Integration of DHTs

Through this scoping review, we found that DHTs show obvious diversity and integration in the form of technology app, which can be divided into 3 main types: digital health tools, real-time remote support, and asynchronous communication. These encompass 10 specific formats including wearable devices, app, website, digital video, social media platform, telephone, group meeting, remote counseling sessions, email, and SMS text messaging. In this scoping review, we found that apps are the main intervention tool for digital CR, and wearable devices are key for real-time data monitoring; their combined application represents the most prevalent model.

From a technical support perspective, digital health tools are primarily oriented toward patient self-management and health monitoring. This aligns with the findings of van Olmen et al [75], who concluded that digital health tools can effectively empower individuals to engage in self-management and advance the achievement of relevant health goals. Real-time remote support emphasizes direct interpersonal interaction between clinicians and patients, preserving the inherent humanistic care inherent in traditional health care [76]. For instance, studies by Ryan et al [77] integrated empathy and care into remote interactions, revealing no significant difference in perceived humanistic care compared to in-person consultations. Asynchronous communication, leveraging flexible information delivery, provides patients with continuous health reminders and educational support [15].

These 3 complementary levels synergistically construct a multitiered, multidimensional, and comprehensive rehabilitation support system spanning patient self-management to real-time clinician-patient interaction. This provides a viable pathway for developing personalized, multimodal CR models. Notably, some studies further integrate offline face-to-face guidance, forming a blended rehabilitation model combining online and offline approaches [37,38,54,56]. This aligns with findings from Thomas et al [78], confirming that a comprehensive digital technology app significantly enhances the individualized adaptability of CR. Compared to traditional rehabilitation methods, this blended model partially addresses limitations such as relatively monotonous formats and insufficient consideration of individual differences [79].

The Multifaceted Application Objectives of DHTs

In this scoping review, we found that DHTs exhibit multifaceted features in terms of intervention goals, which can be divided into 4 main dimensions: motivation and guidance, foundation of knowledge and skills, monitoring and security, and social and group dynamics. A total of 15 specific objectives have been identified. Health education, data monitoring, and reminders and alerts form the core layer; feedback, goal setting, and personalized interventions constitute the secondary layer; while some studies incorporate distinctive features such as gamification, rewards, and social support.

All interventions integrate multidimensional objectives, with health education appearing most frequently, highlighting the central role of knowledge transfer [80]. Features like gamification and social support effectively address patient issues such as lack of motivation and difficulty sustaining behavior [41,50,57]. This aligns with the WHO Global Digital Health Strategy’s advocacy for “patient-centered approaches to achieve sustainable behavioral change” [17]. This multidimensional goal integration enables DHTs to systematically tackle key barriers to participation in traditional CR [78]. Knowledge gaps can be addressed through health education, motivation deficits remedied by gamified incentives, and sustained support ensured via social interaction [81]. It is precisely this composite application model that has evolved DHTs from fragmented tools into systematic rehabilitation support systems. This significantly enhances the comprehensiveness and continuity of rehabilitation interventions, providing a crucial pathway for advancing patients with CHD understanding of CR and enabling precision-targeted interventions [15].

Effect Evaluation

Analysis of multidimensional assessment indicators across 43 included studies demonstrates that DHTs exhibit clear short-term intervention value for CR of patients with CHD. However, evidence for long-term clinical outcomes remains scarce, strongly aligning with the findings of positive short- to medium-term effects and insufficient long-term evidence.

Regarding clinical physiological indicators, DHTs significantly improve patients’ cardiopulmonary function and physical fitness levels, with statistically significant improvements in core metrics like peak oxygen uptake and 6-minute walk distance observed in intervention groups. They also positively influence blood pressure and lipid control, validating the effectiveness of real-time monitoring and personalized guidance in short-term physiological optimization [39,42,44,49,58,66,70,71]. At the health behavior level, digital technologies significantly enhance rehabilitation adherence in areas like exercise, medication, and diet through mechanisms such as scheduled reminders and real-time feedback. They also correct unhealthy lifestyle habits like prolonged sitting, aligning with findings where health behaviors serve as core assessment dimensions [41,48,51]. Regarding patient-reported outcomes and rehabilitation service use, digital interventions effectively improve patients’ quality of life, disease awareness, and self-efficacy. They also significantly overcome temporal and spatial constraints, increasing rehabilitation participation and completion rates while alleviating barriers to traditional rehabilitation, consistent with outcome-related findings [48,53,54,72].

However, existing studies have not reached a unified conclusion regarding the assessment of long-term clinical outcomes. While some studies observed a downward trend in readmission rates, they failed to demonstrate statistical significance in reducing major adverse cardiovascular events or long-term mortality [40,47,55]. This is closely related to the limited sample sizes and short follow-up periods in most studies, as well as the significant heterogeneity in intervention designs and the lack of systematic long-term rehabilitation management systems. Research on the long-term cost-effectiveness and sustainability of these interventions is also scarce, necessitating further exploration [82].

Advantages and Challenges of DHT

The most significant advantage of DHTs lies in their ability to effectively overcome geographical constraints and economic barriers, substantially enhancing the accessibility of CR and patient participation rates [21]. In this study, we found that by providing easily accessible, user-friendly, and highly interactive digital technologies, it is possible to significantly reduce structural barriers commonly encountered in traditional rehabilitation models, such as transport difficulties, time conflicts, and uneven resource distribution [4]. Research by Varnfield et al [48] confirmed that smartphone-based home rehabilitation significantly outperformed traditional rehabilitation in terms of uptake, adherence, and completion rates among patients with postmyocardial infarction. Ramachandran et al [72] further validated the superiority of home-based remote rehabilitation in enhancing rehabilitation use rates. This finding provides a pathway to high-quality rehabilitation services for remote areas with scarce medical resources and for patients with CHD with limited mobility, positioning DHTs as a crucial strategic tool for bridging geographical disparities in health care resources and advancing equity in cardiovascular health services. However, the widespread adoption of digital technologies also presents a new challenge: the “digital divide” [15]. Older adults, low-income groups, and patients with lower educational attainment may encounter significant difficulties in operating digital devices, using apps, or accessing information [17,83,84].

Therefore, advancing DHT must prioritize equity and inclusivity as core principles [17]. Simplified interfaces and voice-assisted features tailored for older people and low-skilled users should be developed, alongside personalized, face-to-face training in digital technology use [85]. Exploring device subsidies or digital equipment loan schemes for vulnerable groups is essential to overcome digital barriers and encourage active participation in digital CR [83]. Furthermore, key challenges for scaling DHTs include technical feasibility, data security and privacy protection, sustainable cost-effectiveness, and seamless integration of digital interventions into existing clinical workflows [15]. Currently, while some studies have begun examining implementation-level indicators for DHTs, such as the feasibility of smart device monitoring and remote rehabilitation, overall evidence remains limited. Greater practical research and systematic evaluation are urgently needed to advance the standardized application and long-term development of digital CR models [71,86].

Limitations

Although we systematically reviewed the current application of DHTs in CR for patients with CHD through a scoping review methodology, several limitations remain. First, regarding literature sources, we only included peer-reviewed empirical research published in English. While this approach helps ensure the quality of included studies, it may overlook important literature published in other languages and relevant gray literature, thereby affecting the comprehensiveness of the study conclusions. Second, significant methodological heterogeneity among the included studies limited the integration and comparability of results. We varied significantly in intervention design, technology combinations, intervention duration, use frequency, participant characteristics, selected outcome measures, and follow-up periods. Furthermore, most studies featured small sample sizes and short follow-up durations, lacking comprehensive assessments of long-term clinical outcomes, cost-effectiveness, intervention sustainability, and impacts on health equity. This limits a thorough evaluation of the long-term value of DHTs.

Conclusions

In this study, we used a scoping review methodology to systematically examine the current application and practical value of DHTs in CR for patients with CHD. Findings confirm that DHTs effectively improve patients’ short-term physiological function and optimize health behaviors. Simultaneously, they overcome limitations in traditional CR regarding spatial-temporal constraints and health care resource allocation, significantly enhancing patient engagement and adherence to rehabilitation programs. In clinical practice, health care providers can integrate multiple DHTs to develop personalized rehabilitation plans tailored to individual characteristics such as patient age, digital literacy, and disease severity, thereby enhancing the precision and adaptability of CR. Future research should prioritize large-scale, multicenter, long-term follow-up randomized controlled trials to thoroughly investigate the impact of DHTs on long-term clinical outcomes for patients with CHD and explore potential mechanisms of action, such as long-term mortality and major adverse cardiovascular events. This will provide more robust evidence-based support for validating their long-term efficacy and advancing standardized clinical implementation.