Effectiveness of cardiac telerehabilitation with relapse prevention compared to centre-based cardiac rehabilitation: results from the SmartCare-CAD randomised controlled trial

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was part of the SmartCare project, which was partially funded under the ICT Policy Support Programme (ICT PSP), grant agreement number 325158. Background Most studies failed to show superiority of cardiac telerehabilitation (CTR) over traditional, centre-based cardiac rehabilitation (CR). Purpose To evaluate the effectiveness of a novel CTR intervention on the adherence to a physically active lifestyle in patients with coronary artery disease (CAD). Methods We randomised patients with CAD entering phase II outpatient CR to either CTR with relapse prevention by on-demand coaching (intervention group), or centre-based CR with supervised exercise training (control group). The primary outcome measure was objectively assessed physical activity level (PAL), secondary outcome measures included physical fitness and quality of life (QoL). Results A total of 300 patients (89% male, mean age 60.7 ± 9.5 years) participated in the trial. Both groups significantly improved their PAL at 12 months follow-up (p < 0.01), but without a significant between-group difference in the response over time (p = 0.73). Similarly, we observed sustained increases in physical fitness and QoL, but without significant between-group differences in responses over time. Conclusions In patients with CAD who had low residual cardiovascular risk, CTR with relapse prevention resulted in a sustained increase in PAL, physical fitness and QoL, but without differences in responses over time as compared to centre-based CR. For this reason, future CTR interventions should be directed specifically to patients who are at risk for relapse into unhealthy lifestyle behaviour. Main outcome measures Control (centre-based CR) Intervention (CTR) Baseline 3 months 12 months Within groups p-value 0-3 months Within groups p-value 0-12 months Baseline 3 months 12 months Within groups p-value 0-3 months Within groups p-value 0-12 months PAL † 1.40 (0.45) 1.53 (0.48) 1.55 (0.46) <0.001 0.001 1.44 (0.50) 1.67 (0.50) 1.61 (0.46) <0.001 <0.001 Workload (% of expected) * 92.1 ± 19.3 103.6 ± 19.5 104.8 ± 21.0 <0.001 <0.001 91.3 ± 18.6 101.2 ± 18.8 102.5 ± 19.6 <0.001 <0.001 KVL-H total † 5.3 (1.4) 6.1 (1.0) 6.3 (0.9) <0.001 <0.001 5.4 (1.8) 6.0 (1.0) 6.2 (1.0) <0.001 <0.001 CR cardiac rehabilitation; CTR: cardiac telerehabilitation; KVL-H: Kwaliteit van Leven bij Hartpatiënten (quality of life in cardiac patients); PAL: physical activity level. †Values reported as median (interquartile range). Within-groups differences assessed by Wilcoxon signed-rank test. *Values reported as mean ± standard deviation. Within-groups differences assessed by paired samples T-test.