Cardiac Telerehabilitation Program Research Articles

Feasibiliy, safety and patient perceptions of an exercise-based cardiac telerehabilitation programme

Abstract Background Despite proven benefits of exercise-based cardiac rehabilitation (EBCR), few patients with myocardial infarction (MI) complete these programs and there is a need to develop more flexible and evidence-based options. Purpose The aim of this study was to evaluate feasibility, safety, and patient perceptions of remotely delivered EBCR. Methods This study was conducted at 23 cardiac rehabilitation centres during the Covid-19 pandemic (March 2020-September 2022), when access to centre-based EBCR was restricted. A total of 231 patients with MI <80 years were included 2-4 weeks after discharge to participate in a remote EBCR programme 2 times/week for 3-4 months. Exercise was delivered through a real-time group-based video meeting, connecting the physiotherapist to patients exercising at home. Safety monitoring in terms of adverse events (AE) and serious adverse events (SAE) were recorded. Outcomes were assessed before and after remote EBCR completion and comprised tests of physical fitness and questionnaires: self-reported physical activity and exercise (Haskell questionnaire), physical capacity (VAS), kinesiophobia (TSK-Heart), health-related quality of life (EQ5D-VAS), self-efficacy for exercise, and patient acceptance of the program. Results Patients performed in median 19 (Q1 9 - Q3 23) remote EBCR sessions. A total of 16 AEs were registered during exercise (e.g chest pain, syncope, dizziness, musculoskeletal symptoms) which were all resolved. Two SAEs that required hospitalization were reported (chest pain, in-stent restenosis), both unrelated to exercise. At end of remote EBCR, significant improvements in physical fitness, self-reported exercise and physical capacity, kinesiophobia, and health-related quality of life were observed (Table 1). Delta values were similar to previous centre-based EBCR studies. Patients agreed that remote EBCR improved health care access (83%), was easy to use (94%), and 95% found exercise performance and interaction acceptable. Conclusions This study supports that remote EBCR is feasible and safe with a high patient acceptance post-MI. The clinical effectiveness needs to be confirmed in a randomized controlled design.

Exploring the feasibility, acceptability, and safety of a real-time cardiac telerehabilitation and tele coaching programme using wearable devices in people with a recent myocardial infarction.

Cardiac rehabilitation (CR) constitutes the recommended nonpharmacological approach for cardiac patients with cardiovascular disease such as people following a recent (i.e., < 4 week) myocardial infarction (MI). Recent evidence suggests that cardiac telerehabilitation may be as effective as traditional (i.e., in person) CR in people following a recent MI. Nevertheless, the feasibility, acceptability, and safety of such an exercise programme has yet to be examined. Forty-four (11 women, 33 men) people following a recent MI were randomly allocated into two groups (online home-based and gym-based groups). The groups underwent a 24-week CR programme thrice per week. All patients performed the baseline, and 24 weeks follow up measurements where feasibility, acceptability, and safety were assessed. Eligibility and recruitment rates were found to be 61.5% and 42%, respectively. Compliance to the thrice weekly, 24-week exercise programme for the online- and gym-based groups were 91.6% and 90.9%, respectively. There were no dropouts during the exercise programmes, however four participants, two from each group, were lost to follow up at 6 months. The average percentage of peak HR (% HRpeak) for the online group was 66.6% ± 4.5 and for the gym-based group was 67.2% ± 5. The average RPE and affect during exercise was for both groups 12 ± 1 ("somewhat hard") and 3 ± 1 ("good"), respectively. During the 6-month exercise intervention period for both groups, the exercise-induced symptoms were minimal to none. The user suitability evaluation questionnaire revealed that the online real time telerehabilitation and tele coaching programme was enjoyable (4.85 ± 0.37) and did not induce general discomfort (1.20 ± 0.41). Our cardiac telerehabilitation programme seems to be feasible, acceptable, safe, and enjoyable for people with a recent MI. Our participants had an overall positive experience and acceptability of the cardiac telerehabilitation and tele coaching using wearable devices. ClinicalTrial.gov, ID NCT06071273, 10/02/2023, retrospectively registered.

Analysis of adverse events during a cardiac telerehabilitation program: A single-center study.

Analysis of adverse events during a cardiac telerehabilitation program: A single-center study.

Cardiac (tele)rehabilitation in routine clinical practice for patients with coronary artery disease: protocol of the REHAB + trial.

Cardiac rehabilitation programs face the challenge of suboptimal participation, despite being a level Ia recommendation. Cardiac telerehabilitation, with its potential to engage patients who might otherwise not show interest, necessitates the adaption of existing center-based cardiac rehabilitation programs to facilitate rehabilitation at home. REHAB + is a mobile cardiac telerehabilitation program cocreated with patients and rehabilitation centers, aiming to future-proof cardiac rehabilitation and improve accessibility. The REHAB + application enables users to remotely communicate with their coach, receive on-demand feedback on health goal progression, and reduces the need for frequent in-person meetings at the cardiac rehabilitation center. The REHAB + study seeks to compare patient-related outcomes and characteristics of patients between those offered the option to participate in cardiac telerehabilitation and those attending center-based cardiac rehabilitation over a twelve-month period. The REHAB + study is a multicenter, prospective, matched controlled, observational study that includes (N)STEMI patients eligible for cardiac rehabilitation. We aim to enroll 300 participants for cardiac telerehabilitation and 600 for center-based cardiac rehabilitation. Participants opting for cardiac telerehabilitation (REHAB+) will be matched with center-based cardiac rehabilitation participants. Additionally, characteristics of patients unwilling to participate in either center-based rehabilitation or telerehabilitation but are willing to share their demographics will be collected. The primary endpoint is quality of life measured with the SF-36 questionnaire at three and twelve months, with patient-related characteristics driving intervention choice as the most important secondary endpoint. Secondary endpoints include physical activity, modifiable risk factors, and digital health experience. The trial is registered at clinicaltrials.gov with registration number NCT05207072. The REHAB + trial is unique by offering patients freedom to choose between cardiac telerehabilitation and center-based rehabilitation. The integration of digital components into cardiac rehabilitation has the potential to complement behavioral change strategies for specific patient groups. Offering patients the option of cardiac telerehabilitation next to center-based rehabilitation could enhance overall cardiac rehabilitation participation rates.

Home-based transitional cardiac telerehabilitation in older adults post coronary artery bypass grafting: A randomized controlled trial

This randomized controlled trial evaluated the effectiveness of a 12-week home-based transitional cardiac telerehabilitation (Hb-T-CTR) program on health-related quality-of-life and therapeutic self-care in older adults’ post-Coronary Artery Bypass Grafting (CABG). The intervention group (n = 57) underwent Hb-T-CTR, incorporating preoperative counseling, postoperative education, a culturally adapted video, home visits, and telephone counseling, while the control group (n = 61) received standard care. Using the Coronary Revascularization Outcome Questionnaire and the Sidani Doran Therapeutic Self-Care Measure, data were collected at three time points. Results showed significant improvements in overall scores for both health-related quality of life (t1=3.386, P = 0.001; t2=4.224, P < 0.001) and therapeutic self-care (t1=7.104, P < 0.001; t2=4.242, P < 0.001) in the intervention group compared to controls. This telehealth approach provides convenient and accessible rehabilitation services for older adults’ post-CABG and highlights the importance of integrating Hb-T-CTR into routine care for personalized rehabilitation. This study underscores the potential of telehealth tools in overcoming barriers and enhancing patient-centered interventions.

Feasibility of an exercise-based cardiac telerehabilitation program for patients with ischemic heart disease: a pilot study

Feasibility of an exercise-based cardiac telerehabilitation program for patients with ischemic heart disease: a pilot study

Telerehabilitation in patients with recent hospitalisation due to acute decompensated heart failure: protocol for the Tele-ADHF randomised controlled trial

BackgroundCardiac rehabilitation in patients with chronic heart failure (CHF) has favourable effects on exercise capacity, the risk at hospital (re-)admission and quality of life. Although cardiac rehabilitation is generally recommended it is still under-utilised in daily clinical practice, particularly in frail elderly patients after hospital admission, mainly due to low referral and patient-related barriers. Cardiac telerehabilitation (CTR) has the potential to partially solve these barriers. The purpose of this study is to evaluate the effects of CTR as compared to standard remote care after hospital admission on physical functional capacity in CHF patients.MethodsIn this randomised controlled trial, 64 CHF patients will be recruited during hospitalisation for acute decompensated heart failure, and randomised to CTR combined with remote patient management (RPM) or RPM alone (1:1). All participants will start with RPM after hospital discharge for early detection of deterioration, and will be up titrated to optimal medical therapy before being randomised. CTR will start after randomisation and consists of an 18-week multidisciplinary programme with exercise training by physical and occupational therapists, supported by a (remote) technology-assisted dietary intervention and mental health guiding by a physiologist. The training programme consists of three centre-based and two home-based video exercise training sessions followed by weekly video coaching. The mental health and dietary programme are executed using individual and group video sessions. A wrist-worn device enables remote coaching by the physical therapist. The web application is used for promoting self-management by the following modules: 1) goal setting, 2) progress tracking, 3) education, and 4) video and chat communication. The primary outcome measure is physical functional capacity evaluated by the Short Physical Performance Battery (SPPB) score. Secondary outcome measures include frailty scoring, recovery after submaximal exercise, subjective health status, compliance and acceptance to the rehabilitation programme, and readmission rate.DiscussionThe Tele-ADHF trial is the first prospective randomised controlled trial designed for evaluating the effects of a comprehensive combined RPM and CTR programme in recently hospitalised CHF patients. We hypothesize that this intervention has superior effects on physical functional capacity than RPM alone.Trial registrationNetherlands Trial Registry (NTR) NL9619, registered 21 July 2021.

Hybrid cardiac telerehabilitation for coronary artery disease in Australia: a cost-effectiveness analysis

BackgroundTraditional cardiac rehabilitation programs are centre-based and clinically supervised, with their safety and effectiveness well established. Notwithstanding the established benefits, cardiac rehabilitation remains underutilised. A possible alternative would be a hybrid approach where both centre-based and tele-based methods are combined to deliver cardiac rehabilitation to eligible patients. The objective of this study was to determine the long-term cost-effectiveness of a hybrid cardiac telerehabilitation and if it should be recommended to be implemented in the Australian context.MethodsFollowing a comprehensive literature search, we chose the Telerehab III trial intervention that investigated the effectiveness of a long-term hybrid cardiac telerehabilitation program. We developed a decision analytic model to estimate the cost-effectiveness of the Telerehab III trial using a Markov process. The model included stable cardiac disease and hospitalisation health states and simulations were run using one-month cycles over a five-year time horizon. The threshold for cost-effectiveness was set at $AU 28,000 per quality-adjusted life-year (QALY). For the base analysis, we assumed that 80% completed the programme. We tested the robustness of the results using probabilistic sensitivity and scenario analyses.ResultsTelerehab III intervention was more effective but more costly and was not cost-effective, at a threshold of $28,000 per QALY. For every 1,000 patients who undergo cardiac rehabilitation, employing the telerehabilitation intervention would cost $650,000 more, and 5.7 QALYs would be gained, over five years, compared to current practice. Under probabilistic sensitivity analysis, the intervention was cost-effective in only 18% of simulations. Similarly, if the intervention compliance was increased to 90%, it was still unlikely to be cost-effective.ConclusionHybrid cardiac telerehabilitation is highly unlikely to be cost-effective compared to the current practice in Australia. Exploration of alternative models of delivering cardiac telerehabilitation is still required. The results presented in this study are useful for policymakers wanting to make informed decisions about investment in hybrid cardiac telerehabilitation programs.

Hybrid Cardiac Telerehabilitation After Acute Coronary Syndrome: Self-selection Predictors and Outcomes.

To evaluate the effectiveness of a hybrid cardiac telerehabilitation (HCTR) program after acute coronary syndrome (ACS) on patient quality of life (QoL) and physical activity indices throughout phases 2-3 and establish predictors for hybrid program self-selection. This single-centre longitudinal retrospective study included patients who attended a cardiac rehabilitation program (CRP) between 2018-2021. Patients self-selected between two groups: Group 1 - conventional CRP (CCRP); Group 2 - HCTR. Baseline characteristics were registered. EuroQol-5D (EQ-5D) and International Physical Activity Questionnaire (IPAQ) were applied at three times: T0 - phase 2 onset; T1 - phase 3 onset; T2 - 3 months after T1. 59 patients participated (Group 1 - 27; Group 2 - 32). We found significant between-group differences regarding occupation (p=0.003). Diabetic patients were less likely to self-select into HCTR (OR=0.21; p<0.05). EQ-5D visual analogue scale and IPAQ result significantly improved between T0-T2 only for HCTR (p=0.001; p=0.021). HCTR was superior to CCRP on physical activity indices and QoL of ACS patients.

Patients' Perceptions of Exercise-Based Cardiac Telerehabilitation after a Myocardial Infarction-A Qualitative Study.

To be able to design telerehabilitation programs targeting the needs and preferences of end-users, patients' in-depth perspectives are needed. To date, such studies are lacking and, therefore, the aim of the present study was to describe patients' perceptions of performing exercise-based cardiac telerehabilitation after a myocardial infarction (MI). Individual semi-structured interviews were performed with 15 patients (3 women, median age 69 years) after an MI who had participated in exercise-based cardiac telerehabilitation for three months. The interviews were transcribed verbatim and analyzed with inductive content analysis. An overall theme was defined as "Cardiac telerehabilitation-a new alternative for exercising that is easily accessible and up to date". Four categories, including "The important role of a physical therapist with expert knowledge", "Prerequisites playing an important role in the willingness to participate", "Making exercise accessible and adjustable" and "Inspiring future exercise", and 15 subcategories were identified. Understanding the patient's perspective is an important key to further improving and successfully implementing exercise-based cardiac telerehabilitation, as an alternative or adjunct to traditional, centre-based programs. The findings can serve to improve patient-physiotherapist interactions and to inform important aspects related to exercise, technology and a sense of security from an exercise-based cardiac telerehabilitation program.

Cardiac tele-rehabilitation in times of pandemic. Experience at the National Cardiovascular Institute INCOR in Lima-Peru

Cardiac Rehabilitation (CR) programs based on telehealth are an alternative in the context of a pandemic and represent an opportunity to continue in the intervention of cardiovascular diseases (CVD). The present study aims to evaluate the effect of a Cardiac Tele-Rehabilitation (CTR) program on quality of life, anxiety/depression index, exercise safety and Level Of disease awareness in patients discharged from a national referral institute in times of pandemic. A pre-experimental study in cardiac patients who entered the cardiac rehabilitation program at INCOR from August to December 2020. The study included low-risk patients who were administered a questionnaire (on cardiovascular disease, exercise safety, anxiety/depression, and quality of life) at the beginning and end of the program, which was applied through a virtual platform. Descriptive and comparative before-after analysis was used through hypothesis testing. Sixty-four patients were included (71.9% male). The mean age was 63.6 ±11.1 years. Regarding exercise safety, an increase in the mean score was found after the application of the program (3.06 ± 0.8 to 3.18 ± 0.7, p=0.324). Concerning anxiety, the mean score was reduced from 8.61 to 4.75, while for depression, the reduction was from 7.27 to 2.92. Regarding the quality-of-life score, the global component improved from 111.48 to 127.92. The CTR program implemented through a virtual platform during the COVID-19 pandemic enhanced quality of life and decreased stress and depression in cardiac patients discharged from a national cardiovascular referral center.

Effect of a cardiac telerehabilitation program during COVID-19 associated social isolation

This study aimed to compare the impact of a cardiac telerehabilitation (CTR) protocol aimed at patients with cardiovascular diseases (CVDs) during the period of coronavirus disease 2019 (COVID-19) associated with social isolation. This retrospective cohort study included 58 participants diagnosed with stable cardiovascular diseases (CVDs), which were divided into three groups: conventional cardiac rehabilitation (CCR) group (n ​= ​20), composed of patients undergoing conventional cardiac rehabilitation; cardiac telerehabilitation (CTR) group (n ​= ​18), composed of patients undergoing cardiac telerehabilitation and control group (n ​= ​20), composed of patients admitted for cardiac rehabilitation who had not started training programs. The results showed that body mass index was reduced (p ​= ​0.019) and quality of life was improved (e.g., limitations due to physical aspects [p ​= ​0.021), vitality [p ​= ​0.045] and limitations due to emotional aspects [p ​= ​0.024]) by CCR compared to baseline. These outcomes were not improved by CTR (p ​> ​0.05). However, this strategy prevented clinical deterioration in the investigated patients. Although CCR achieved a superior effect on clinical improvement and quality of life, CTR was relevant to stabilize the blood pressure and quality of life of patients with cardiovascular diseases during the period of COVID-19-associated social isolation.

Cardiac telerehabilitation with long-term follow-up reduces GlycA and improves lipoprotein particle profile: A randomised controlled trial

BackgroundA 10-month strategy of cardiac telerehabilitation (CTR) improved outcomes over a standard centre-based cardiac rehabilitation (CBCR), as recently published. We hypothesised that prolonged telerehabilitation could also improve proinflammatory status and lipoprotein particle composition. MethodsA randomised controlled trial compared a prolonged CTR program with CBCR in post-ACS patients. Patient's age was 18–72 years with low-risk criteria. Blood samples were drawn at baseline, at 4- and 10-months follow-up. Advanced lipoprotein characterization was performed using the NMR-based Liposcale test. Signals from glycoproteins (GlycA and GlycB) were also assessed. ResultsThe final analysis included 31 patients in the CTR group and 25 patients in the CBCR group. GlycA decreased in the CTR group (p = 0,007). LDL particle number (LDL-P) increase in both groups, but it was at the expense of small-sized LDL in the CBCR group (p = 0.012). Triglycerides in intermediate-density lipoprotein (IDL-TG) increased only in the CBCR group (p = 0.043). The triglyceride-to-HDL (TG/HDL) ratio decreased only in the CTR group (p = 0.006). The TG/HDL ratio was correlated with GlycA (Spearman's correlation coefficient: 0.558, p < 0.001) but not with CRP (p = 0.101). ConclusionsOur results showed that a 10-month CTR program reduced GlycA levels, the TG/HDL ratio and avoided unfavourable long-term changes in lipoprotein particle composition.Registration at http://ClinicalTrials.gov. NCT number: 04942977

Perspectives on Participation in a Feasibility Study on Exercise-Based Cardiac Telerehabilitation After Transcatheter Aortic Valve Implantation: Qualitative Interview Study Among Patients and Health Professionals.

BackgroundAortic valve stenosis affects approximately half of people aged ≥85 years, and the recommended surgical treatment for older patients is transcatheter aortic valve implantation (TAVI). Despite strong evidence for its advantages, low attendance rate in cardiac rehabilitation is observed among patients after TAVI. Cardiac telerehabilitation (CTR) has proven comparable with center-based rehabilitation; however, no study has investigated CTR targeting patients after TAVI. On the basis of participatory design, an exercise-based CTR program (TeleTAVI) was developed, which included a web-based session with a cardiac nurse, a tablet containing an informative website, an activity tracker, and supervised home-based exercise sessions that follow the national recommendations for cardiac rehabilitation.ObjectiveThis study aims to explore patients’ and health professionals’ experiences with using health technologies and participating in the exercise-based CTR program, TeleTAVI.MethodsThis study is a part of a feasibility study and will only report patients’ and health professionals’ experiences of being a part of TeleTAVI. A total of 11 qualitative interviews were conducted using a semistructured interview guide (n=7, 64% patients and n=4, 36% health professionals). Patient interviews were conducted after 8 weeks of participation in TeleTAVI, and interviews with health professionals were conducted after the end of the program. The analysis was conducted as inductive content analysis to create a condensed meaning presented as themes.ResultsReticence toward using the website was evident with reduced curiosity to explore it, and reduced benefit from using the activity tracker was observed, as the patients’ technical competencies were challenged. This was also found when using the tablet for web-based training sessions, leading to patients feeling worried before the training, as they anticipated technical problems. Disadvantages of the TeleTAVI program were technical problems and inability to use hands-on guidance with the patients. However, both physiotherapists and patients reported a feeling of improvement in patients’ physical fitness. The home training created a feeling of safety, supported adherence, and made individualization possible, which the patients valued. A good relationship and continuity in the contact with health professionals seemed very important for the patients and affected their positive attitude toward the program.ConclusionsThe home-based nature of the TeleTAVI program seems to provide the opportunity to support individualization, autonomy, independence, and adherence to physical training in addition to improvement in physical capability in older patients. Despite technological challenges, basing the relationship between the health professionals and patients on continuity may be beneficial for patients. Prehabilitation may also be considered, as it may create familiarity toward technology and adherence to the training.

Efficacy, efficiency and safety of a cardiac telerehabilitation programme using wearable sensors in patients with coronary heart disease: the TELEWEAR-CR study protocol

IntroductionExercise-based cardiac rehabilitation (CR) is a beneficial tool for the secondary prevention of cardiovascular diseases with, however, low participation rates. Telerehabilitation, intergrading mobile technologies and wireless sensors may advance the...

Telerehabilitation in patients with recent hospitalization due to acute decompensated heart failure: protocol for the Tele-ADHF randomised controlled trial

Abstract Funding Acknowledgements Type of funding sources: None. Background/introduction Cardiac rehabilitation (CR) has favourable effects in chronic heart failure (CHF) patients on exercise capacity, the risk at hospital (re-)admission and quality of life. Although CR is generally recommended, it is still under-utilized in the daily clinical practice partly due to logistics reasons, limited availability, and patient-related barriers. Cardiac telerehabilitation (CTR) could solve some of these barriers, and have the same favourable outcomes. Purpose The aim of this study is to investigate if CTR in recently hospitalized CHF patients improves their physical functional capacity when compared to no rehabilitation. Methods This randomised controlled trial compares CTR with no rehabilitation after hospitalization for acute decompensated heart failure (ADHF). 64 patients will be included during hospitalization, and start with Remote Patient Management (RPM). After a short period of stable CHF, the patients will be randomised for RPM combined with CTR (intervention group), or RPM alone (control group). The intervention group will start with an 18-weeks program with exercise training, supported by a (remote) technology-assisted dietary intervention and mental health guiding. The training program starts with three centre-based and two home-based video training sessions followed by video coaching sessions. The primary endpoint is physical functional capacity, evaluated using the Short Physical Performance Battery (SPPB) score. Secondary endpoints are recovery after submaximal exercise by evaluating VO2 recovery kinetics (τ-rec), subjective health status, health related quality of life, compliance and acceptance, and readmission rate. Future implications This will be the first study to use an CTR program with integrated RPM after hospitalization for ADHF.

A 12-week cardiac telerehabilitation programme does not prevent relapse of physical activity levels: long-term results of the FIT@Home trial.

A 12-week cardiac telerehabilitation programme does not prevent relapse of physical activity levels: long-term results of the FIT@Home trial.

A randomized controlled clinical trial of cardiac telerehabilitation with a prolonged mobile care monitoring strategy after an acute coronary syndrome.

BackgroundCenter‐based cardiac rehabilitation (CBCR) improves health outcomes but has some limitations. We designed and validated a telerehabilitation system to overcome these barriers.MethodsWe included 67 low‐risk acute coronary syndrome patients in a randomized controlled trial allocated 1:1 to a 10‐month cardiac telerehabilitation (CTR) program or an 8‐week CBCR program. Patients underwent ergospirometry, blood tests, anthropometric measurements, IPAQ, PREDIMED, HADS, and EQ‐5D questionnaires at baseline and 10 months. Data collectors were blinded to the treatment groups.ResultsThe intention‐to‐treat analysis included 31 patients in the CTR group and 28 patients in the CBCR group. The primary outcome showed increased physical activity according to the IPAQ survey in the CTR group compared to the CBCR group (median increase 1726 METS‐min/week vs. 636, p = .045). Mean VO2max increased 1.62 ml/(kg min) (95% confidence interval [CI]: 0.56–2.69, p < .004) from baseline in the CTR group, and 0.60 mL/(kg min) (p = .40) in the CBCR group. Mean apoB/apoA‐I ratio decreased 0.13 (95% CI: −0.03 to 0.24, p = .017) in the CTR group, with no significant change in the CBCR group (p = .092). The median non‐HDL cholesterol increased by 7.3 mg/dl (IQR: −2.4 to 18.6, p = .021) in the CBCR group, but the increase was not significant in the CTR group (p = .080). Adherence to a Mediterranean diet, psychological distress, and quality of life showed greater improvement in the CTR group than in the CBCR group. Return‐to‐work time was reduced with the telerehabilitation strategy.ConclusionThis system allows minimal in‐hospital training and prolonged follow‐up. This strategy showed better results than CBCR.

Hybrid cardiac telerehabilitation program as a potential strengthening factor in the quality of life in patients with coronary heart disease: a retrospective single-centre analysis

Abstract Cardiac rehabilitation (CR) has well known beneficial effects on physical capacity, health-related quality of life, morbidity and mortality in patients with coronary artery disease (CAD). However, underuse of CR and not sustained improvements have been noted. It has been proposed that telemonitored exercise-based CR, by the use of mobile applications, can improve patient adherence to CR programs providing better outcomes. The aim of this study was to investigate the effects of telemonitored cardiac rehabilitation on physical capacity, health-related quality of life and control of cardiovascular risk factors among patients with CAD on phase 2 of the Cardiac Rehabilitation Program (CRP). A retrospective study was conducted and patients in CRP between 2017 and 2020 were included. Patient selection and information collection were obtained through medical records. Outcomes were Body Mass Index, Hospital Anxiety and Depression Scale (HADS), EuroQol-5D score (EQ-5D), International Physical Activity Questionnaire (IPAQ), estimated functional capacity in cardiac stress test, lipid panel and glycated hemoglobin. Patients were divided into two groups: group 1 followed the conventional strategy and group 2 followed a hybrid telemonitored CRP, with the use of MOVIDA mobile application. Variables were analysed in the beginning (T0) and in the end (T1) of the phase 2, around 3 months after. Group comparisons tests and multivariate logistic regression were performed. A p-value less than 0.05 is statistically significant. Statistical analysis was performed using SPSS software v25.0. We analysed 107 patients, which 93 of these were assiduous and 69 concluded the phase 2 of CRP: 44 patients in group 1 and 25 patients in group 2. Two groups have similar baseline characteristics, except for age (p=0.02). It appears that participation in the PRC led to an improvement in physical capacity, mental well-being, and in lipid panel, regardless of the strategy. The improvement in quality of life, quantified by EQ-5D, was significant only in group 2 (p=0.03). There is also no correlation between age and the differences recorded in EQ-5D (p=0.86). We hypothesise that, when compared to conventional CRP, cardiac telemonitored exercise using modern communication methods and on-demand coaching will result in an improved behavioural change, which translates to higher quality of life. Further studies including more patients and the phase 3 of CRP are needed to confirm these results. Funding Acknowledgement Type of funding sources: None.

MI-PACE Home-Based Cardiac Telerehabilitation Program for Heart Attack Survivors: Usability Study.

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.