Feasibility of hybrid telerehabilitation as a component of the Managed Care after Acute Myocardial Infarction (MC-AMI) program in a 12-month follow-up: experience from a single center.

Abstract

Managed Care after Myocardial Infarction (MC‑AMI [KOS-Zawał]), a comprehensive care program dedicated to patients after myocardial infarction, was implemented in Poland in 2017. Hybrid cardiac telerehabilitation (HTR) is a unique component of MC‑AMI. We evaluated the feasibility of HTR as a component of MC‑AMI and assessed its safety and acceptance by patients. One‑year all‑cause mortality among the patients participating and not participating in MC‑AMI was analyzed. The MC‑AMI group included 114 patients who underwent a 5‑week HTR program comprising telemonitored Nordic walking training sessions, and who completed the entire 12‑month MC‑AMI program. The influence of HTR on the physical capacity was assessed by comparing the stress test results before and after HTR. After HTR, the patients completed a satisfaction survey to assess their acceptance of the program. The non-MC‑AMI group was formed using propensity score matching to compare 1‑year all‑cause mortality between the patients participating and not participating in MC-AMI. HTR significantly improved the functional capacity assessed in the stress test and was well‑received by the patients. In the study group, nonfatal non-ST‑segment elevation myocardial infarction, elective coronary percutaneous intervention, and cardiovascular hospitalization occurred in 0.9%, 2.6% and 6.1% of the patients, respectively. There were no deaths among the MC‑AMI participants, whereas in the non-MC‑AMI group, 1‑year all‑cause mortality was 3.5%. The log‑rank test comparing the survival probabilities of matched groups, estimated by the Kaplan-Meier method, showed heterogeneity of the curves (P = 0.04). HTR as a component of MC‑AMI was a feasible, safe, and well‑accepted form of cardiac rehabilitation. Participation in MC‑AMI including HTR was associated with a significantly lower risk of 1‑year all‑cause mortality, as compared with not taking part in the rehabilitation program.