Abstract
BackgroundCardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction.ObjectiveIn this pilot study, we aimed to developed and assess the feasibility of delivering a health watch–informed 12-week cardiac telerehabilitation program to acute myocardial infarction survivors who declined to participate in center-based cardiac rehabilitation.MethodsWe enrolled patients hospitalized after acute myocardial infarction at an academic medical center who were eligible for but declined to participate in center-based cardiac rehabilitation. Each participant underwent a baseline exercise stress test. Participants received a health watch, which monitored heart rate and physical activity, and a tablet computer with an app that displayed progress toward accomplishing weekly walking and exercise goals. Results were transmitted to a cardiac rehabilitation nurse via a secure connection. For 12 weeks, participants exercised at home and also participated in weekly phone counseling sessions with the nurse, who provided personalized cardiac rehabilitation solutions and standard cardiac rehabilitation education. We assessed usability of the system, adherence to weekly exercise and walking goals, counseling session attendance, and disease-specific quality of life.ResultsOf 18 participants (age: mean 59 years, SD 7) who completed the 12-week telerehabilitation program, 6 (33%) were women, and 6 (33%) had ST-elevation myocardial infarction. Participants wore the health watch for a median of 12.7 hours (IQR 11.1, 13.8) per day and completed a median of 86% of exercise goals. Participants, on average, walked 121 minutes per week (SD 175) and spent 189 minutes per week (SD 210) in their target exercise heart rate zone. Overall, participants found the system to be highly usable (System Usability Scale score: median 83, IQR 65, 100).ConclusionsThis pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch–based program and telephone counseling sessions. Usability and adherence to health watch use, exercise recommendations, and counseling sessions were high. Further studies are warranted to compare patient outcomes and health care resource utilization between center-based rehabilitation and telerehabilitation.
Highlights
Cardiac rehabilitation provides longitudinal cardiopulmonary exercise training with additional disease management interventions to patients with cardiovascular diseases [1,2]
This pilot study established the feasibility of delivering cardiac telerehabilitation at home to acute myocardial infarction survivors via a health watch–based program and telephone counseling sessions
Of the 62 patients who were eligible, 57 were approached, and 31 (54.4%) consented to participate and completed baseline interviews. Of these 31 individuals, participation in the cardiac telerehabilitation program was deemed to be safe for 20 individuals who successfully completed the baseline stress test (Figure 1)
Summary
Cardiac rehabilitation provides longitudinal cardiopulmonary exercise training with additional disease management interventions to patients with cardiovascular diseases [1,2]. Many eligible patients never receive referrals for cardiac rehabilitation, and a high proportion of patients who receive referrals never enroll [5,6,7,8,9,10]. This may be due to numerous factors, such as cost of enrollment, lack of motivation, or inadequate patient education regarding the benefits of cardiac rehabilitation [2]. Cardiac rehabilitation programs, consisting of exercise training and disease management interventions, reduce morbidity and mortality after acute myocardial infarction
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