CUOREMA: Immersive Bio & Behavioral Feedback and Digital Interventions for Cardiac Rehabilitation - Exploratory Analysis

Cardiac rehabilitation is critical for secondary prevention, yet long-term adherence remains low. We present CUOREMA, a new personalized mobile health system integrating self-monitoring diaries, wearable data, virtual coaching, and reinforcement learning-enhanced adaptive interventions to support lifestyle change during and after outpatient cardiac rehabilitation. In a six-month two-center feasibility study (N = 53, Switzerland and France), we evaluated usability, engagement patterns, and preliminary health-related outcomes. Attrition was high: only 19% of participants used the app on more than 100 days, and questionnaire response rates declined from 55% at baseline to 13% at six months. Des