Home-based Exercise Rehabilitation Using Remote Monitoring In Left Ventricular Assist Device Recipients: Pilot Data From The Prospective Move-lvad Study

Abstract

Introduction Home-based exercise rehabilitation (HER), using a wearable activity monitor and smartphone app, may be an alternative to supervised cardiac rehabilitation in new left ventricular assist device (LVAD) recipients. The aim of the MOVE-LVAD study is to provide data on the feasibility, safety, and efficacy of HER. Hypothesis: We hypothesize that HER, compared to usual care (UC), is safe and associated with improved activity levels. Methods MOVE-LVAD is a randomized, controlled study conducted at a single center. We aim to prospectively enroll 30 new HeartMate 3 (HM3) LVAD recipients. Subjects in both the HER and UC groups wear an activity watch continuously to monitor daily steps. Patients in the HER group also use a smartphone app to rate perceived exertion on the Borg scale and complete video calls with an exercise physiologist. Daily steps and Borg rating are used to titrate exercise prescriptions in the HER group. Endpoints include effects of HER, compared to UC, on functional status and healthcare utilization. Results We provide functional and outcome data on the first ten patients enrolled in MOVE-LVAD through April, 2021. Four patients (mean age 66 years) were randomized to HER and six patients (mean age 55 years) to UC. Average daily steps at baseline and during follow-up in the two groups are shown in the Figure. At baseline, median daily steps were similar in the HER and UC groups (535 [IQR 355, 1319] vs. 572 [IQR 217, 1812], respectively; p=1.00). In the HER group, median daily steps were significantly increased from baseline to 8556 (IQR 5081, 12030) at 4-months (p=0.05). In contrast, in the UC group, median daily steps were not significantly different between baseline and 4-months (1078 [IQR 962, 1193] p=0.52). There were no major adverse events associated with HER. One patient in the UC group was rehospitalized for non-VAD infection. Conclusions Our preliminary data from the MOVE-LVAD study suggest that HER using remote monitoring is feasible, safe, and may lead to improved activity levels in newly implanted HM3 LVAD patients. Home-based exercise rehabilitation (HER), using a wearable activity monitor and smartphone app, may be an alternative to supervised cardiac rehabilitation in new left ventricular assist device (LVAD) recipients. The aim of the MOVE-LVAD study is to provide data on the feasibility, safety, and efficacy of HER. Hypothesis: We hypothesize that HER, compared to usual care (UC), is safe and associated with improved activity levels. MOVE-LVAD is a randomized, controlled study conducted at a single center. We aim to prospectively enroll 30 new HeartMate 3 (HM3) LVAD recipients. Subjects in both the HER and UC groups wear an activity watch continuously to monitor daily steps. Patients in the HER group also use a smartphone app to rate perceived exertion on the Borg scale and complete video calls with an exercise physiologist. Daily steps and Borg rating are used to titrate exercise prescriptions in the HER group. Endpoints include effects of HER, compared to UC, on functional status and healthcare utilization. We provide functional and outcome data on the first ten patients enrolled in MOVE-LVAD through April, 2021. Four patients (mean age 66 years) were randomized to HER and six patients (mean age 55 years) to UC. Average daily steps at baseline and during follow-up in the two groups are shown in the Figure. At baseline, median daily steps were similar in the HER and UC groups (535 [IQR 355, 1319] vs. 572 [IQR 217, 1812], respectively; p=1.00). In the HER group, median daily steps were significantly increased from baseline to 8556 (IQR 5081, 12030) at 4-months (p=0.05). In contrast, in the UC group, median daily steps were not significantly different between baseline and 4-months (1078 [IQR 962, 1193] p=0.52). There were no major adverse events associated with HER. One patient in the UC group was rehospitalized for non-VAD infection. Our preliminary data from the MOVE-LVAD study suggest that HER using remote monitoring is feasible, safe, and may lead to improved activity levels in newly implanted HM3 LVAD patients.