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

Ernesto Dalli Peydró, Nuria Sanz Sevilla, María T Tuzón Segarra, Vicente Miró Palau, Jorge Sánchez Torrijos, Juan Cosín Sales, Ernesto Dalli Peydró, Nuria Sanz Sevilla, María T Tuzón Segarra, Vicente Miró Palau, Jorge Sánchez Torrijos, Juan Cosín Sales

Abstract

Background: Center-based cardiac rehabilitation (CBCR) improves health outcomes but has some limitations. We designed and validated a telerehabilitation system to overcome these barriers.

Methods: We 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.

Results: The 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.

Conclusion: This system allows minimal in-hospital training and prolonged follow-up. This strategy showed better results than CBCR.

Keywords: cardiac rehabilitation; coronary heart disease; secondary prevention; telemedicine; telerehabilitation.

Conflict of interest statement

The authors declare that there are no conflict of interests.

© 2021 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.

Figures

Figure 1
Figure 1
CONSORT patient flow diagram for nonpharmacologic treatment trials
Figure 2
Figure 2
Changes in self‐reported physical activity through the International Physical Activity Questionnaire (IPAQ) (Panel A). Changes in maximal oxygen uptake (VO2max) during cardiopulmonary exercise testing (Panel B). CBCR, center‐based cardiac rehabilitation; CTR, cardiac telerehabilitation
Figure 3
Figure 3
Effect of prolonged cardiac telerehabilitation (CTR) and center‐based cardiac rehabilitation (CBCR) on apoB/apoA‐I ratio, non‐HDL cholesterol, total cholesterol, and LDL cholesterol at the 10‐month follow‐up

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