Do we keep cardiac patients out of hospital by adding telerehabilitation to standard rehabilitation?

Abstract

Background: Standard in-hospital cardiac rehabilitation (CR) has been proven to be effective. Cardiac patients however often do not attend these rehabilitation sessions leading to noncompliance with lifestyle and risk factor recommendations, which is associated with increased adverse outcomes. Objectives: We investigated whether the addition of an internet-based rehabilitation program to standard CR can reduce the number of cardiovascular rehospitalisations. Methods: The Telerehab III study is a multi-centric randomized controlled trial, that runs from February 2013-2015. Coronary artery disease or heart failure patients were eligible. Intervention patients (n=70) were, at study start, stratified in different subgroups based on their cardiovascular risk factor profile and cardiopulmonary exercise testing. This stratification enabled the caregiver to provide each patient with a personalised diet and exercise protocol. The intervention patients were asked to wear a motion sensor continuously for a total study period of 6 months. Each week, they received feedback messages (via e-mail and/or SMS) to gradually increase their activity level and to inform them about healthy diets. Control patients (n=70) wore taped motion sensor three times for 9 days (week 1, 6 and 24) for measurement purposes only. They did not receive feedback regarding their physical activities via SMS or e-mail, nor did they receive dietary advice. Results: The Kaplan-Meier curve showed a significant lower rehospitalisation rate in the intervention group (P=0.01055) (13 rehospitalisations), when compared to the control group (29 rehospitalisations). Conclusions: The addition of an internet-based telerehabilitation program to standard CR can impact favorably on cardiovascular rehospitalisation rate.