Home-based Cardiac Telerehabilitation Research Articles

The WALK HOP program: a French innovative multicentric home-based cardiac rehabilitation initiative

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fonds pour l'innovation du système de santé (FISS) - France. Background Cardiac rehabilitation (CR) has demonstrated scientific benefits in terms of morbidity and mortality. In France, 2019 national data indicates that only 22,3% of coronary patients benefit from CR. The development of alternative programs to center-based cardiac rehabilitation (CBCR) must be considered as a public health priority and requires a reorganization of ambulatory care pathways. Purpose The objective of the "Walk Hop" program is to demonstrate that home-based cardiac tele-rehabilitation (HBCT) is a complementary and safe approach to CBCR, able to increase the proportion of patients benefiting from a rehabilitation program. Methods This feasibility study started begin of 2022. 3,200 coronary patients will be recruited in 8 participating cardiac rehabilitation centers (CRC). Total duration of the experiment is 42 months. The program is financially supported by the French authorities. The HBCT solution developed for the study is proposed to patients by the CRC cardiologist. A multidisciplinary platform consisting of a secure portal and an application allows bidirectional communication. Patients are equiped with a cycle ergometer and a validated heart rate monitor. The application presents aerobic and muscle strenghtening activities and therapeutic education and collects data from the sessions carried out, adherence to the program, symptoms and quality of life. Results By october 2022, 157 active patients have been included in the program with a large majority of men (86%). Mean age is 53,9 ± 9,0. Hypercholesterolemia is noted in 36,9% of the included patients, smoking in 31%, arterial hypertension in 30,6% and diabetes in 11,1%. Obesity/overweight affects 60% of the population. Mean time from angioplasty to initiation of the rehabilitation is 81 ± 90 days. Mean number of home rehabilitation sessions is 21 and a total of 3342 home sessions have been realized. No cardiovascular event or rehospitalization have been registered since the beginnng. Mean adherence to the prescribed sessions is 80 ± 20% and the mean power gain at the end of the program is 14,6 ± 9,9 %. 94% of the patients expressed satisfaction or high satisfaction at the end of the program. Conclusion(s) The Walk Hop program is evaluating the feasibility and acceptability of HBCT with remote monitoring and digital assistance by smartphone. The preliminary data are encouraging in view of the final expected impact: greater cost-effective access to rehabilitation programs by removing obstacles like distance or resumption of work. It is also expected that HBCT will provide an improvement in the long-term maintenance benefits.

Effectiveness of home-based cardiac telerehabilitation in patients with heart failure: A systematic review and meta-analysis of randomised controlled trials.

To evaluate the effectiveness of home-based cardiac telerehabilitation in patients with heart failure. This systematic review and meta-analysis of randomised controlled trials were designed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two researchers independently screened eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias within the included studies. A fixed- or random-effects meta-analysis model was used to determine the mean difference, based on the results of the heterogeneity test. A librarian-designed search of the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI and Wanfang databases was conducted to identify studies in English or Chinese on randomised controlled trials up to 15 August 2022. A total of 2291 studies were screened. The meta-analysis included data from 16 studies representing 4557 participants. The results indicated that home-based cardiac telerehabilitation could improve heart rate, VO2 peak, 6-minute walk distance, quality of life and reduce readmission rates. No significant differences were observed in the left ventricular ejection fraction percentages between the home-based cardiac telerehabilitation and usual care groups. Compared with centre-based cardiac rehabilitation, home-based cardiac telerehabilitation showed no significant improvement in outcome indicators. Patients with heart failure benefit from home-based cardiac telerehabilitation intervention. With the rapid development of information and communication technology, home-based cardiac telerehabilitation has great potential and may be used as an adjunct or substitute for centre-based cardiac rehabilitation. This systematic review and meta-analysis found that patients with heart failure would benefit from home-based cardiac telerehabilitation intervention in terms of cardiac function, functional capacity, quality-of-life management and readmission rate. Future clinical interventions should consider home-based cardiac telerehabilitation as an alternative to conventional cardiac rehabilitation in patients with heart failure to improve their quality of life. Our paper is a systematic review and meta-analysis, and such details do not apply to our work.

Effects of home-based cardiac telerehabilitation programs in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

BackgroundRecent advances in telecommunications technology have raised the possibility of telehealth intervention delivering cardiac telerehabilitation, which may provide the efficacy of health services in patients after percutaneous coronary intervention (PCI). This study aimed to investigate the effects of home-based cardiac telerehabilitation (HBCTR) in patients undergoing PCI.MethodsWe performed a comprehensive search of the following electronic databases: PubMed, Cochrane Central, Web of Science, Embase, CNKI, and WANFANG. For the prespecified outcomes, the primary outcomes were results of physical function (the six-minute walking test, 6MWT) and quality of life (QoL) of the participants. The secondary outcomes were results of (1) blood pressure; (2) full lipid profile (3) reliable assessment of anxiety and depression in patients.ResultsAll studies were conducted between 2013 and 2022, and a total of 5 articles could be included in the quantitative meta-analysis. The results showed that there was a statistically significant difference between the HBCTR intervention group and the control group in 6WMT (MD 16.59, 95%CI 7.13 to 26.06, P = 0.0006), but there was no difference in QoL (SMD − 0.25, 95%CI − 1.63 to 1.13, P = 0.73). According to the fixed effects model, there was a statistically significant difference between the HBCTR group versus the control group (MD − 2.88, 95%CI − 5.19 to − 0.57, P = 0.01), but not in diastolic blood pressure. Likewise, significant improvements of triglycerides and in low-density lipoprotein cholesterol were observed in HBTCR groups, but no significant differences were observed regarding total cholesterol and high-density lipoprotein cholesterol.ConclusionThis systematic review and meta-analysis have proven that the HBCTR is one of the promisingly effective cardiac rehabilitation strategies that improve cardiorespiratory fitness and reduce cardiovascular disease risk factors. With the continuous improvement of the telerehabilitation network, it is expected to serve in clinical.

Cardiac Rehabilitation For Coronary Artery Disease Patients- A Literature Review

ABSTRACT Background and purpose: This literature review objective is to appraise the outcome of Cardiac Rehabilitation for (CAD) patients. Methods: This literature review constitutes the articles which were published in 2017-2022. The evidence search was performed on Google Scholar, PubMed database and Web of science. Results: According to 34 studies incorporated in our literature review shows that cardiac rehabilitation has led to enhancing the well-being of patients suffering from (CAD). We performed a literature review of different articles, including seven studies that were randomised control trials and seven studies that were systematic reviews, and three studies that were meta-analyses providing evidence on the benefits of cardiac rehabilitation and its recent advances in (CAD) patients. Discussion: This literature review, according to selective studies, demonstrates that routine exercise habits act as a precautionary regimen in patients suffering from (CAD). It has led to enhancement in cardiovascular strength and decreasing fatness in a healthy population. Exercise Based (CR) has also shown remarkable outcomes in enhancing the well-being of patients suffering from (CAD). Keywords: Coronary artery disease, cardiac rehabilitation, home-based cardiac telerehabilitation, exercise-based cardiac rehabilitation.

Home-Based Robotic Upper Limbs Cardiac Telerehabilitation System.

This article proposes a new, improved home-based cardiac telerehabilitation system enhanced by a robotic and Virtual Reality module for cardiac patients to be used in their rehabilitation program. In this study, a novel strategy was used to integrate existing equipment and applications with newly developed ones, with the aim of reducing the need for technical skills of patients using remote control. Patients with acute or chronic heart diseases require long-term, individualized rehabilitation in order to promote their motor recovery and maintain an active and independent lifestyle. This will be accomplished by creating a system for at-home cardiac telerehabilitation augmented by a VR and cobot systems, which can be used long-term at home by each individual patient. In the pre-feasibility study carried out on healthy volunteers familiar with software applications and robotic systems, we demonstrate that RoboTeleRehab could be technically feasible both hardware and software.

Effectiveness of home-based telerehabilitation programs on functional capacity and cardiac function in elderly heart failure patients: A prospective longitudinal study.

Decreased functional capacity and reduced cardiac function were the main symptoms in patients with heart failure (HF) and the incidence increases with advanced age. The guidelines recommend that exercise training should be considered for medically stable HF outpatients. Studies have confirmed that exercise can improve functional capacity, prognosis, and reduced hospitalization rates; however, very few studies have investigated the elderly. It is not clear whether exercise could be feasible in elderly HF. The aim of this study was to evaluate the effect of the 6-month heart failure post-acute care program focused on home-based cardiac telerehabilitation (HCTR) on functional capacity, cardiac function, and readmission rates in HF patients. A prospective longitudinal study was conducted. Study duration was from January 2018 to December 2019. HF patients with a left ventricular ejection fraction <40% and age ≧65 years were included and divided into intervention (n = 40) and control group (n = 41). We arranged a 6-month heart failure post-acute care program that included outpatient cardiac rehabilitation and home exercise for the intervention group. The response to home exercise was followed by telemonitor. The exercise parameters were recorded on the HF health management mobile application system platform by each patient and daily transmission to hospital's cloud database as HCTR, usual care program for the control group. Information such as general data, laboratory data, six-minute walk test, cardiac function, and admission record was collected from all patients. Eighty one patients between the ages of 65 and 92 completed the study. The mean age was 73.3 ± 5.0 and 75.6 ± 6.0 years in control and intervention group, respectively. The intervention group showed a statistically significant improvement in functional capacity, percentage change in the of six-minute walk distance (51.2% vs 17.7%, P < .05, 95% confidence interval -45.9 to -6.3). Left ventricular ejection fraction increased by 7.7%, which corresponds to 25.6% in relative terms (P < .05, 95% confidence interval -7.8 to -0.5). The readmission rate was 4.6% in the intervention group. Six months of post-acute HF focused on HCTR programs was safe, improved functional capacity, cardiac function, and decreased readmission rate in elderly patients with HF patients.

Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review.

BackgroundAn understanding of the technology acceptance of home-based cardiac telerehabilitation programs is paramount if they are to be designed and delivered to target the needs and preferences of patients with coronary heart disease; however, the current state of technology acceptance of home-based cardiac telerehabilitation has not been systematically evaluated in the literature.ObjectiveWe aimed to provide a comprehensive summary of home-based cardiac telerehabilitation technology acceptance in terms of (1) the timing and approaches used and (2) patients’ perspectives on its usability, utility, acceptability, acceptance, and external variables.MethodsWe searched PubMed, CENTRAL, Embase, CINAHL, PsycINFO, and Scopus (inception to July 2021) for English-language papers that reported empirical evidence on the technology acceptance of early-phase home-based cardiac telerehabilitation in patients with coronary heart disease. Content analysis was undertaken.ResultsThe search identified 1798 studies, of which 18 studies, with 14 unique home-based cardiac telerehabilitation programs, met eligibility criteria. Technology acceptance (of the home-based cardiac telerehabilitation programs) was mostly evaluated at intra- and posttrial stages using questionnaires (n=10) and usage data (n=11). The least used approach was evaluation through qualitative interviews (n=3). Usability, utility, acceptability, and acceptance were generally favored. External variables that influenced home-based cardiac telerehabilitation usage included component quality, system quality, facilitating conditions, and intrinsic factors.ConclusionsHome-based cardiac telerehabilitation usability, utility, acceptability, and acceptance were high; yet, a number of external variables influenced acceptance. Findings and recommendations from this review can provide guidance for developing and evaluating patient-centered home-based cardiac telerehabilitation programs to stakeholders and clinicians.

Effectiveness of home-based cardiac telerehabilitation as an alternative to Phase 2 cardiac rehabilitation of coronary heart disease: a systematic review and meta-analysis.

AimsThe onset of the COVID-19 pandemic saw the suspension of centre-based cardiac rehabilitation (CBCR) and has underscored the need for home-based cardiac telerehabilitation (HBCTR) as a feasible alternative rehabilitation delivery model. Yet, the effectiveness of HBCTR as an alternative to Phase 2 CBCR is unknown. We aimed to conduct a meta-analysis to quantitatively appraise the effectiveness of HBCTR.Methods and resultsPubMed, EMBASE, CENTRAL, CINAHL, Scopus, and PsycINFO were searched from inception to January 2021. We included randomized controlled trials (RCTs) comparing HBCTR to Phase 2 CBCR or usual care in patients with coronary heart disease (CHD). Out of 1588 studies, 14 RCTs involving 2869 CHD patients were included in this review. When compared with usual care, participation in HBCTR showed significant improvement in functional capacity {6-min walking test distance [mean difference (MD) 25.58 m, 95% confidence interval (CI) 14.74–36.42]}; daily step count (MD 1.05 K, 95% CI 0.36–1.75) and exercise habits [odds ratio (OR) 2.28, 95% CI 1.30–4.00)]; depression scores (standardized MD −0.16, 95% CI −0.32 to 0.01) and quality of life [Short-Form mental component summary (MD 2.63, 95% CI 0.06–5.20) and physical component summary (MD 1.99, 95% CI 0.83–3.16)]. Effects on medication adherence were synthesized narratively. HBCTR and CBCR were comparably effective.ConclusionIn patients with CHD, HBCTR was associated with an increase in functional capacity, physical activity (PA) behaviour, and depression when compared with UC. When HBCTR was compared to CBCR, an equivalent effect on functional capacity, PA behaviour, QoL, medication adherence, smoking behaviour, physiological risk factors, depression, and cardiac-related hospitalization was observed.

Cardiac Rehabilitation Based on the Walking Test and Telerehabilitation Improved Cardiorespiratory Fitness in People Diagnosed with Coronary Heart Disease during the COVID-19 Pandemic.

This study investigated an alternative home-based cardiac telerehabilitation model in consideration of the recommendations for the COVID-19 quarantine of people diagnosed with coronary heart disease (CHD). We hypothesized that using a 200 m fast walking test (200 mFWT) and telerehabilitation would create an effective alternative cardiac rehabilitation (CR) intervention that could improve cardiorespiratory fitness. Participants (n = 19, mean age 60.4 ± 9.6) of the 8-week intervention performed regular physical exercise at the target heart rate zone determined by calculations based on the 200 mFWT results. In our study, the participants were supervised using telerehabilitation. A total of 84% of participants completed the 8-week intervention. No adverse events were reported during telerehabilitation. The study participants noted a significant improvement (p < 0.001) in cardiorespiratory fitness expressed by an 8% reduction in the walking test time (Δ 8.8 ± 5.9 s). Home-based telerehabilitation based on 200 mFWT effectively increased the cardiorespiratory fitness in people with CHD with a low to moderate cardiovascular risk. This was a novel approach in CR during the COVID-19 pandemic. As research in this area is justified, this paper may serve as an alternative method of providing healthcare during the COVID-19 pandemic and as a basis for further upcoming randomized controlled trials.

Home-based cardiac telerehabilitation (CR-GPS) study. Rationale and design of a randomized controlled trial to evaluate the exercise intervention on patients after cardiovascular disease

Aim: Cardiovascular rehabilitation (CR) is recommended as an important part of a comprehensive approach to prevention and risk management of cardiovascular disease (CVD). Although the CR programs bring a lot of benefits, participation of patients remains low. Development of telemedicine and mobile technologies provides the opportunity to improve effectiveness of CR programs by enabling almost real-time observing patients´ physical activity. The purpose of this prospective study is investigating feasibility and effect of home based tele-rehabilitation in patients with CVD.

Attitudes towards acceptance of an innovative home-based and remote sensing rehabilitation protocol among cardiovascular patients in Shantou, China.

BackgroundCardiac rehabilitation (CR) protocols have diversified to include home-based cardiac tele-rehabilitation (HBCTR) as an alternative to hospital-based or center-based CR. To adopt the use of home-based cardiac tele-rehabilitation, it is necessary to assess cardiac patients' attitudes towards acceptance of such e-health technology, especially in China where knowledge of such technology is deficient.MethodsInterviews were conducted in the First Affiliated Hospital of Shantou University Medical College, Shantou, China. After percutaneous coronary interventional (PCI) surgery, patients completed the survey.ResultsAmong the 150 patients, only 13% had ever heard of HBCTR. After an introduction of our HBCTR program, 60% of patients were willing to participate in the program. From our multivariate analysis of questionnaire data, age (OR: 0.92, 95% CI: 0.86–0.98; P = 0.007), average family monthly income (OR: 0.13, 95% CI: 0.05–0.34; P < 0.001), education level (OR: 0.24, 95% CI: 0.10–0.59; P = 0.002) and physical exercise time (OR: 0.19, 95% CI: 0.06–0.56; P = 0.003) were independent predictors for acceptance of HBCTR. From the reasons for participation, patients selected: enhanced safety and independence (28.3%), ability to self-monitor physical conditions daily (25.4%), and having automatic and emergency alert (23.1%). Reasons for refusal were: too cumbersome operation (34.3%) and unnecessary protocol (19.4%).ConclusionsMost patients lacked knowledge about HBCTR but volunteered to participate after they have learned about the program. Several personal and life-style factors influenced their acceptance of the program. These indicate that both improvement of technology and better understanding of the program will enhance active participation.

Effects of outpatient followed by home-based telemonitored cardiac rehabilitation in patients with coronary artery disease.

Cardiac rehabilitation (CR) has been shown to reduce the cardiovascular mortality of patients with coronary artery disease (CAD) and help people to return to professional work. Unfortunately, limited accessibility and low participation levels present persistent challenges in almost all countries where CR is available. Applying telerehabilitation provides an opportunity to improve the implementation of and adherence to CR, and it seems that the hybrid form of training may be the optimal approach due to its cost-effectiveness and feasibility for patients referred by a social insurance institution. To present the clinical characteristics and evaluate the effects of hybrid: outpatient followed by home-based cardiac telerehabilitation in patients with CAD in terms of exercise tolerance, safety, and adherence to the programme. A total of 125 patients (112 men, 13 women) with CAD, aged 58.3 ± 4.5 years, underwent a five-week training programme (TP) consisting of 19-22 exercise training sessions. The first stage of TP was performed in the ambulatory form of CR in hospital; then, patients continued to be telemonitored TP at home (hybrid model of cardiac rehabilitation - HCR). Before and after completing CR, all patients underwent a symptom-limited treadmill exercise stress test. Adherence was reported by the number of dropouts from the TP. The number of days of absence in the HCR programme was 1.50 ± 4.07 days. There were significant improvements (p < 0.05) in some measured variables after HCR in the exercise test: max. workload: 7.86 ± 2.59 METs vs. 8.88 ± 2.67 METs; heart rate (HR) at rest: 77.59 ± 12.53 bpm vs. 73.01 ± 11.57 bpm; systolic blood pressure at rest: 136.69 ± 17.19 mm Hg vs. 130.92 ± 18.95 mm Hg; double product at rest: 10623.33 ± 2262.97 vs. 9567.50 ± 2116.81; HRR1: 97.46 ± 18.27 bpm vs. 91.07 ± 19.19 bpm; and, NYHA class: 1.18 ± 0.48 vs. 1.12 ± 0.35. In patients with documented CAD, HCR is feasible and safe, and adherence is good. Most patients were on social rehabilitation benefit, had a smoking history, and suffered from hypertension, obesity, or were overweight. A hybrid model of CR improved exercise tolerance.

Feasibility of home-based cardiac telerehabilitation: Results of TeleInterMed study

Cardiac rehabilitation (CR) is recommended as an important component of a comprehensive approach to cardiovascular disease (CVD) patients. Data have shown that a small percentage of eligible patients participate in CR despite their well established benefits. Applying telerehabilitation provides an opportunity to improve the implementation of and adherence to CR. The purpose of the study was to evaluate a wide implementation and feasibility of home-based cardiac telerehabilitation (HTCR) in patients suffering from CVD and to assessits safety, patients' acceptance of and adherence to HTCR. The study included 365 patients (left ventricular ejection fraction 56 ± 8%; aged 58 ± 10 years). They participated in 4-week HTCR based on walking, nordic walking or cycloergometer training. HTCR was telemonitored with a device adjusted to register electrocardiogram (ECG) recording and to transmit data via mobile phone to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with CR. The influence on physical capacity was assessed by comparing changes - in time of exercise test, functional capacity, 6-min walking test distance from the beginning and the end of HTCR. At the end of the study, patients filled in a questionnaire in order to assess their acceptance of HTCR. HTCR resulted in a significant improvement in all parameters. There were neither deaths nor adverse events during HTCR. Patients accepted HTCR, including the need for interactive everyday collaboration with the monitoring center. There were only 0.8% non-adherent patients. HTCR is a feasible, safe form of rehabilitation, well accepted by patients. The adherence to HTCR was high and promising.