Home-based cardiac rehabilitation using information and communication technology for heart failure patients with frailty

Yuta Nagatomi, Tomomi Ide, Tae Higuchi, Tomoyuki Nezu, Takeo Fujino, Takeshi Tohyama, Takuya Nagata, Taiki Higo, Toru Hashimoto, Shouji Matsushima, Keisuke Shinohara, Tomiko Yokoyama, Aika Eguchi, Ayumi Ogusu, Masataka Ikeda, Yusuke Ishikawa, Fumika Yamashita, Shintaro Kinugawa, Hiroyuki Tsutsui, Yuta Nagatomi, Tomomi Ide, Tae Higuchi, Tomoyuki Nezu, Takeo Fujino, Takeshi Tohyama, Takuya Nagata, Taiki Higo, Toru Hashimoto, Shouji Matsushima, Keisuke Shinohara, Tomiko Yokoyama, Aika Eguchi, Ayumi Ogusu, Masataka Ikeda, Yusuke Ishikawa, Fumika Yamashita, Shintaro Kinugawa, Hiroyuki Tsutsui

Abstract

Aims: Cardiac rehabilitation (CR) is an evidence-based, secondary preventive strategy that improves mortality and morbidity rates in patients with heart failure (HF). However, the implementation and continuation of CR remains unsatisfactory, particularly for outpatients with physical frailty. This study investigated the efficacy and safety of a comprehensive home-based cardiac rehabilitation (HBCR) programme that combines patient education, exercise guidance, and nutritional guidance using information and communication technology (ICT).

Methods and results: This study was a single-centre, open-label, randomized, controlled trial. Between April 2020 and November 2020, 30 outpatients with chronic HF (New York Heart Association II-III) and physical frailty were enrolled. The control group (n = 15) continued with standard care, while the HBCR group (n = 15) also received comprehensive, individualized CR, including ICT-based exercise and nutrition guidance using ICT via a Fitbit® device for 3 months. The CR team communicated with each patient in HBCR group once a week via the application messaging tool and planned the training frequency and intensity of training individually for the next week according to each patient's symptoms and recorded pulse data during exercise. Dietitians conducted a nutritional assessment and then provided individual nutritional advice using the picture-posting function of the application. The primary outcome was the change in the 6 min walking distance (6MWD). The participants' mean age was 63.7 ± 10.1 years, 53% were male, and 87% had non-ischaemic heart disease. The observed change in the 6MWD was significantly greater in the HBCR group (52.1 ± 43.9 m vs. -4.3 ± 38.8 m; P < 0.001) at a 73% of adherence rate. There was no significant change in adverse events in either group.

Conclusions: Our comprehensive HBCR programme using ICT for HF patients with physical frailty improved exercise tolerance and improved lower extremity muscle strength in our sample, suggesting management with individualized ICT-based programmes as a safe and effective approach. Considering the increasing number of HF patients with frailty worldwide, our approach provides an efficient method to keep patients engaged in physical activity in their daily life.

Keywords: Cardiac rehabilitation; Exercise tolerance; Frailty; Heart failure; Home rehabilitation; Telemedicine.

Conflict of interest statement

H.T. reports receiving personal fees from MSD, Astellas, Pfizer, Bristol‐Myers Squibb, Otsuka Pharmaceutical, Daiichi‐Sankyo, Mitsubishi Tanabe Pharma, Nippon Boehringer Ingelheim, Takeda Pharmaceutical, Bayer Yakuhin, Novartis Pharma, Kowa Pharmaceutical, Teijin Pharma, Medical Review Co., and the Japanese Journal of Clinical Medicine; non‐financial support from Actelion Pharmaceuticals, Japan Tobacco Inc., Mitsubishi Tanabe Pharma, Nippon Boehringer Ingelheim, Daiichi‐Sankyo, IQVIA Services Japan, and Omron Healthcare Co.; and grants from Astellas, Novartis Pharma, Daiichi‐Sankyo, Takeda Pharmaceutical, Mitsubishi Tanabe Pharma, and Teijin Pharma, MSD, outside the submitted work. The other authors declare no conflicts of interest associated with this manuscript.

© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Figures

Figure 1
Figure 1
Comprehensive home‐based cardiac rehabilitation programme using information and communication technology.
Figure 2
Figure 2
Study flow chart. 6MWD, 6 min walking distance; BMI, body mass index; HBCR, home‐based cardiac rehabilitation.
Figure 3
Figure 3
The change in the 6MWD from baseline. 6MWD, 6 min walking distance; HBCR, home‐based cardiac rehabilitation.

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