Abstract
Background: The impact of cardiac rehabilitation on the number of alerts in patients with remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is unknown. We compared alerts in RM and outcomes in patients with CIEDs undergoing hybrid comprehensive telerehabilitation (HCTR) versus usual care (UC). Methods: Patients with heart failure (HF) after a hospitalization due to worsening HF within the last 6 months (New York Heart Association (NYHA) class I-III and left ventricular ejection fraction (LVEF) ≤40%) were enrolled in the TELEREH-HF study and randomised 1:1 to HCTR or UC. Patients with HCTR and CIEDs received RM (HCTR-RM). Patients with UC and CIEDs were offered RM optionally (UC-RM). Data from the initial 9 weeks of the study were analysed. Results: Of 850 enrolled patients, 208 were in the HCTR-RM group and 62 in the UC-RM group. The HCTR-RM group was less likely to have alerts of intrathoracic impedance (TI) decrease (p < 0.001), atrial fibrillation (AF) occurrence (p = 0.031) and lower mean number of alerts per patient associated with TI decrease (p < 0.0001) and AF (p = 0.019) than the UC-RM group. HCTR significantly decreased the occurrence of alerts in RM of CIEDs, 0.360 (95%CI, 0.189–0.686; p = 0.002), in multivariable regression analysis. There were two deaths in the HCTR-RM group (0.96%) and no deaths in the UC-RM group (p = 1.0). There were no differences in the number of hospitalised patients between the HCTR-RM and UC-RM group (p = 1.0). Conclusions: HCTR significantly reduced the number of patients with RM alerts of CIEDs related to TI decrease and AF occurrence. There were no differences in mortality or hospitalisation rates between HCTR-RM and UC-RM groups.
Highlights
Heart failure (HF) guidelines recommend regular exercise training in patients with heart failure (HF) to improve symptoms, functional capacity, and to reduce the risk of HF hospitalisation [1]
From 2015 to 2017, 2333 patients were screened in five centres, and, 425 patients were randomised to the hybrid comprehensive telerehabilitation (HCTR) group and 425 to the usual care (UC) group
Among 425 patients assigned to the HCTR group, 328 (77.2%) patients had an implantable cardioverter–defibrillator (ICD)/CRT-D implanted and 213 of them received remote monitoring (RM), but for technical reasons, five patients were excluded from the analysis (HCTR-RM group, n = 208 (48.9%))
Summary
Heart failure (HF) guidelines recommend regular exercise training in patients with HF to improve symptoms, functional capacity, and to reduce the risk of HF hospitalisation (class 1A recommendation) [1]. Despite clear indications for cardiac rehabilitation in patients with HF and for RM in subjects with CIEDs, data on the influence of cardiac rehabilitation on the number of alerts in RM of CIEDs from multicentre randomised trials are lacking. The present subanalysis from the Telerehabilitation in Heart Failure Patients (TELEREH-HF) randomised clinical trial aimed: (i) to compare alerts, including arrhythmic events, recorded in RM in a population of patients with ICDs/CRT-Ds undergoing hybrid comprehensive telerehabilitation (HCTR-RM group) vs usual care (UC-RM group); and (ii) to compare outcomes of patients in the HCTR-RM and UC-RM groups
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