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Open research questions in Cardiac Health and Mental Health

63 unresolved questions extracted from the limitations and future-work sections of 818 Cardiac Health and Mental Health papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • The prognostic value of preoperative functional status measures, including self‐perceived health, the physical domain of the MacNew heart‐related quality of life score, and estimated maximum oxygen consumption for long‐term mortality remains unclear.

    Functional Status Indicators and Long‐Term Mortality Following Elective Coronary Artery Bypass Grafting: A Multicenter Cohort Study · 2026 · DOI

  • Objective Serious mental illness is associated with excess cardiovascular risk, but outcomes after contemporary percutaneous coronary intervention (PCI) remain unclear.

    Cardiovascular Outcomes After Percutaneous Coronary Intervention in Patients With Serious Mental Illness · 2026 · DOI

  • Although lipid-lowering drugs are firmly established for plaque regression, the impact of exercise-based CR on plaque regression remains underexplored, prompting synthesis of existing evidence.

    Exercise-based cardiac rehabilitation and atherosclerotic plaque regression in ASCVD: Is exercise really a game-changer? A scoping review of controlled trials · 2026 · DOI

  • Treatments such as coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) are common; however, their long-term effects on patient quality of life (QoL), particularly in developing nations, are not well understood.

    Comparative analysis of quality of life post coronary angioplasty and bypass surgery: A follow-up study on cardiac patients · 2026 · DOI

  • This feasibility study has several limitations. First, the sample size was small, and the efficacy of gamified smartphone apps should be evaluated in larger RCTs. In the absence of a control group, the observed improvements in peak VO2 and VAS scores may be attributable, at least in part, to natural physiological recovery during the early postmyocardial infarction phase rather than to the intervention itself. Second, as mentioned, participation rates were low, potentially introducing selection bias. Furthermore, this study included a predominantly male population (94%), which may limit the generalizability of the findings to female patients. As noted in a recent American Heart Association scientific statement, women are known to have lower participation https://cardio.jmir.org/2026/1/e85808 rates in CR programs due to multifactorial barriers. Therefore, caution should be exercised when extrapolating these feasibility findings to female patients. In addition, as “routine smartphone use” was set as the inclusion criterion, patients affected by the digital divide—such as older adults, those without smartphones (the primary reason for exclusion), or those without stable internet access—may have been excluded, potentially limiting the study’s generalizability. The same applies to patients with HF; there were almost no patients with concomitant HF in this study, and even when considering the existing study on mHealth, the conclusions remain controversial. However, the prior research has highlighted the importance of “digital health readiness” in addressing this issue. This study did not collect data on patients’ educational attainment or digital literacy. These factors may influence the feasibility of CTR and the level of engagement with digital health interventions. Future research should consider introducing tools such as digital health readiness questionnaires to further enhance patient engagement. Third, although the app can be installed on patients’ personal iPhones, it was developed exclusively for iOS because of budgetary constraints, which may have affected the generalizability of the findings. To avoid exclusion of patients based on device type, all patients in this study were uniformly provided with an iPhone and an Apple Watch. However, this device-loaning model may be economically challenging to implement in clinical practice. A bring-yourown-device approach, in which patients install the app on their own smartphones, may offer greater cost-effectiveness and user satisfaction. In the subsequent study (the GamiHeart II study), a bring-your-own-device design has been adopted to enhance feasibility and real-world implementability. Furthermore, the devices used in this study were not the latest models at the time of intervention. Therefore, technical inconveniences such as battery drain may partially reflect hardware-related limitations rather than inherent flaws of the software intervention itself. Furthermore, missing data related to hardware functionality may have contributed to the underestimation of exercise adherence based on target HR (Table S2 in Multimedia Appendix 1). Future evaluations using next-generation devices may yield different usability results. Fourth, although gamification is an integral component of the app used in this study, it is not an isolated feature but is closely intertwined with other functionalities. For example, feedback messages in this study are commonly seen in smartphone apps and vary greatly in nature, ranging from those similar to what physicians provide to patients in routine clinical practice to those designed to enhance motivation for earning monetary or nonmonetary rewards within the app. Separating the gamification elements of this app from other aspects of health care can sometimes be difficult. Although creating an app linked to more “game-like” elements, such as puzzle games, might allow measurement of gamification capabilities, the results observed in this study likely reflect the combined effect of the entire app, including its gamification features. JMIR Cardio 2026 | vol. 10 | e85808 | p.

    Cardiac Telerehabilitation Using a Smartwatch and a Gamified Smartphone App: Single-Arm Pre-Post Feasibility Study · 2026 · DOI

  • • Studies vary widely in terms of exercise type (e.g., aerobic, resistance, HIIT, MICT), duration (ranging from 3 weeks to 1 year), and intensity. • Most studies assess outcomes immediately post-intervention, with few extending beyond 6–12 months. • The sustainability biomarker improvements (e.g., reductions in hsCRP, IL- 6, copetin) over time remains unclear. of • Long-term data are essential to determine whether CR leads to lasting reductions in cardiovascular risk. • Many studies focus predominantly on male participants, with limited data on women, elderly patients, or those with comorbidities like diabetes or metabolic syndrome. This restricts the generalizability of findings and overlooks potential gender-specific or condition-specific to cardiac rehabilitation. responses • There is no uniform biomarker panel used across studies; while hsCRP and IL-6 are common, others like BNP, copeptin, VCAM- 1, and FGF21 appear sporadically.

    Effects of Exercise-Based Cardiac Rehabilitation on Cardiac Inflammatory Markers in Coronary Artery Disease - A Narrative Review · 2026 · DOI

  • 22a 22b 23a 23b 24a 24b 25 26 27 28 29 30 For each group, the numbers of participants who were randomly assigned, received intended intervention, and were analysed for the primary outcome For each group, losses and exclusions after randomisation, together with reasons Dates defining the periods of recruitment and follow-up for outcomes of benefits and harms If relevant, why the trial ended or was stopped Intervention and comparator as they were actually administered (eg, where appropriate, who delivered the intervention/comparator, how participants adhered, whether they were delivered as intended (fidelity)) Concomitant care received during the trial for each group A table showing baseline demographic and clinical characteristics for each group For each primary and secondary outcome, by group: ● the number of participants included in the analysis ● the number of participants with available data at the outcome time point ● result for each group, and the estimated effect size and its precision (such as 95% confidence interval) ● for binary outcomes, presentation of both absolute and relative effect size All harms or unintended events in each group Any other analyses performed, including subgroup and sensitivity analyses, distinguishing pre-specified from post hoc Interpretation consistent with results, balancing benefits and harms, and considering other relevant evidence Trial limitations, addressing sources of potential bias, imprecision, generalisability, and, if relevant, multiplicity of analyses 10-11 11 Citation: Hopewell S, Chan AW, Collins GS, Hróbjartsson A, Moher D, Schulz KF, et al. CONSORT 2025 Statement: updated guideline for reporting randomised trials. BMJ. 2025; 388:e081123. https://dx.doi.org/10.1136/bmj-2024-081123 © 2025 Hopewell et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. *We strongly recommend reading this statement in conjunction with the CONSORT 2025 Explanation and Elaboration and/or the CONSORT 2025 Expanded Checklist for important clarifications on all the items. We also recommend reading relevant CONSORT extensions. See www.consort-spirit.org.

    Effectiveness of a Telehealth Intervention on Functional Status, Anxiety, Depression, and Rehospitalization Among Older Adults Undergoing Coronary Artery Bypass Grafting: Randomized Controlled Trial. · 2026 · DOI

  • The consistent reduction in mortality and all-cause read- missions suggests that TC can be a valuable component of long-term management for patients with chronic cardiovas- cular conditions. The stronger effects observed in short-term mortality and in patients with fewer prior hospitalizations indicate that early implementation, before recurrent clinical deterioration, may maximize benefit. However, the absence of significant reductions in cardio- vascular- or heart failure-specific hospitalizations suggests that TC should be integrated as part of a comprehensive care strategy rather than as a standalone intervention aimed at reducing disease-specific admissions. Clinicians should consider TC as a supportive tool to enhance monitoring, improve adherence, and identify early signs of decompensa- tion, particularly in lower-risk patients. Future research should aim to standardize TC protocols, better define patient subgroups most likely to benefit, and conduct adequately powered trials evaluating disease-spe- cific hospitalization endpoints.

    Telemonitoring and telecare in cardiovascular diseases: a systematic review and meta-analysis of randomized controlled trials · 2026 · DOI

  • The limitation of the study is that it was conducted in a single center and cannot be generalized to the entire population. RESULTS AND DISCUSSION The average age of the participating patients was 60.81±1.46 years. The age range was found to be 30-87. While 60.6 % were male, 53.3% had primary school education. When patients’ clinical features were analysed, it was found that 48.5% underwent ACBG surgery, 58.8% had another chronic disease, and 53.3% reportedly could take care of themselves (Table 1). Table 1.

    An Investigation of The Relationship Between Perceived Social Support And Care Dependency In Patients Who Underwent Cardiovascular Surgery Intervention · 2024 · DOI

  • Psychosocial stressors and mood disorders represent under-recognized and undertreated risk factors for CVD that may play a role in propagating gender-based disparities.

    Implications of Sex Differences on Behavioral and Cardiovascular Health · 2022 · DOI

  • ConclusionsThe potential health benefits and cost savings as a result of LICBT for patients who present to ED's with non‐cardiac chest pain warrant further investigation utilising a robust and economically validated trial.

    Can low intensity cognitive behavioural therapy for non‐cardiac chest pain presentations to an emergency department be efficacious? A pilot study · 2019 · DOI

  • Currently, information is lacking as to which BPAs are available and utilized in physical therapy settings in the United States, rationale for inclusion of BPAs in patient care plans and perceptions of importance of inclusion in a DPT curriculum.

    Trends in availability and usage of biophysical agents among physical therapists in the United States · 2018 · DOI

  • BACKGROUND: The effectiveness of stationary and ambulatory cardiac rehabilitation of patients with coronary artery disease (CAD) and diabetes has been proven by some authors, but data concerning the effects of hybrid forms of cardiac rehabilitation (HCR) in this population are lacking.

    Influence of a hybrid form of cardiac rehabilitation on exercise tolerance in coronary artery disease patients with and without diabetes · 2015 · DOI

  • Though much evidence indicates that work stress increases the risk of incident of coronary heart disease (CHD), little is known about the role of work stress in the development of recurrent CHD events.

    Work stress and the risk of recurrent coronary heart disease events: A systematic review and meta-analysis · 2014 · DOI

  • However, since studies in this crucial research area are lacking in Sweden a Swedish version of IPQ-R was validated with a focus on the seven subscales: timeline acute/chronic, timeline cyclical, consequences, personal control, treatment control, illness coherence and emotional representations.

    Validation of the Revised Illness Perception Questionnaire (IPQ‐R) in a sample of persons recovering from myocardial infarction – the Swedish version · 2011 · DOI

  • The state of the current research suggests that future investigations should focus on 1) clarifying the mediators and moderators most relevant in the association between mastery and downstream disease, 2) testing the association between mastery and biological outcomes longitudinally, 3) examining the physiological impact of mastery-increasing interventions, and 4) studying the relationship between mastery and disease risk in diverse ethnic or sociocultural groups.

    Toward a more complete understanding of the effects of personal mastery on cardiometabolic health. · 2011 · DOI

  • Although gaps in the knowledge base exist and several methodological concerns limit the evidence, this body of work suggests that age, personal resources, low rates of physician referral, and weak recommendations to participate in rehabilitation may explain why women are missing from this life-saving intervention.

    Why Are Women Missing from Outpatient Cardiac Rehabilitation Programs? A Review of Multilevel Factors Affecting Referral, Enrollment, and Completion · 2002 · DOI

  • concerning work, diet, medication, and in other aspects of self-care. stance the patient, his family, and society suffer, and the resultant problems are familiar to social workers in all settings. pro vided individualized services to these pa tients in an effort to help them work through their anxiety and make the neces sary adjustments to their illness. Basically, the approach has been to encourage the expression of conscious fears regarding re currence and death and to clarify miscon ceptions before they become so ingrained they are difficult in the personality that to change. Many patients, however, have not been able to utilize individual service because their fear and anxiety lead them to deny the problem or to resort to other forms of resistance.

    A Group Approach to the Cardiac Patient · 1960 · DOI

  • However, these findings have not been consistently replicated, and the stability, incremental predictive value, and independence of Type D personality from depression, disease severity, and other psychosocial factors remain debated.

    Type A and Type D Personality in Cardiovascular Health: A Narrative Review · 2026 · DOI

  • This review provides a critical narrative synthesis of supportive and conflicting evidence and highlights the methodological limitations that currently prevent definitive causal or prognostic conclusions.

    Type A and Type D Personality in Cardiovascular Health: A Narrative Review · 2026 · DOI

  • Although vascular dysfunction has been associated with depressive symptoms, the role of accessible peripheral vascular and autonomic measures in relation to concurrent questionnaire-defined depressive symptom burden in gastroenterology settings remains insufficiently studied.

    Vascular and autonomic correlates of screening-positive depressive symptom burden in chronic atrophic gastritis: a multicenter observational study protocol · 2026 · DOI

  • However, fewer than half of cardiologists ask about depression symptoms in their patients, and with screening measures not being routinely utilized, depression remains under-recognized in this patient population.

    Depression following coronary artery bypass grafting surgery revisited · 2016 · DOI

  • CONCLUSIONS: Future research should focus on relations between behavioural and physiological mechanisms and on the effects of pharmacologic and psychotherapeutic treatments for depression on candidate mechanisms.

    Coronary Heart Disease and Depression: A Review of Recent Mechanistic Research · 2006 · DOI

  • These findings have implications for health service providers in that they suggest that illness perceptions need to be explored and addressed before the decision to attend a programme of cardiac rehabilitation is made and health-promoting behaviours adopted.

    The Illness Perceptions of Women Following Acute Myocardial Infarction: Implications for Behaviour Change and Attendance at Cardiac Rehabilitation · 2006 · DOI

  • The personal and financial toll exacted by recovery from myocardial infarction (Ml) once women are released from the hospital has not been systematically studied.

    Going it alone: Women managing recovery from acute myocardial infarction · 1995 · DOI

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63 open questions have been extracted from the limitations and future-work passages of 818 Cardiac Health and Mental Health papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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