The iATTEND Trial: A Trial Comparing Hybrid Versus Standard Cardiac Rehabilitation

Abstract

The improving ATTENDance (iATTEND) to cardiac rehabilitation (CR) trial tested the hypotheses that hybrid cardiac rehabilitation (HYCR = combination of virtual and in-facility CR sessions) would result in greater attendance compared to traditional, facility-based only CR (FBCR) and yield equivalent improvements in exercise capacity and health status. Patients were randomized to HYCR (n=142) or FBCR (n=140), stratified by sex and race. Attendance was assessed as number of CR sessions completed within 6 mo (primary end-point) and % patients completing 36 CR sessions. Other end-points (tested for equivalency) included exercise capacity and self-reported health status. HYCR patients completed 1 to 12 sessions in-facility, with the balance completed virtually using synchronized, two-way audiovisual technology. Neither total number of CR sessions completed within 6 mo (29±12 vs 28±12 visits, adjusted P= 0.94) nor % of patients completing 36 sessions (59±4% vs 51±4%, adjusted P=0.32) were significantly different between HYCR and FBCR, respectively. The between group changes for exercise capacity (peak oxygen uptake, 6-minute walk distance) and health status were equivalent. Regarding safety, no sessions required physician involvement, there was 1 major adverse event after a virtual session, and no falls requiring medical attention. In conclusion, although we rejected our primary hypothesis that attendance would be greater with HYCR versus FBCR, we showed that FBCR and HYCR resulted in similar patient attendance patterns and equivalent improvements in exercise capacity and health status. HYCR that incorporates virtually supervised exercise should be considered an acceptable alternative to FBCR.NCT identifier: 03646760; The Improving ATTENDance to Cardiac Rehabilitation Trial - Full Text View - ClinicalTrials.gov; https://classic.clinicaltrials.gov/ct2/show/NCT03646760