Phase III cardiac telerehabilitation after inpatient cardiac rehabilitation II improves coronary atery disease patients self-care and knowledge: results of a pilot study

Introduction: The majority of coronary artery disease (CAD) patients (pts) do not continue regular physical exercise and find it difficult to incorporate other healthy lifestyle recommendations into daily life after cardiac rehabilitation (CR) programs. To reduce these obstacles, we used a cardiac telerehabilitation (CTR) program for further vital parameters monitoring, pts support and consultations. Aim: To assess the feasibility and effectiveness of the CTR system for CAD pts in phase III CR. Methods: A pilot study of a prospective, single-center, randomized controlled trial carried out in cardiac rehabilitation inpatient hospital. Inclusion criteria: age 18-65 y., 6 minutes walking distance (6MWD) >225 m., referred to II phase CR after interventional treatment of CAD. Pts (n=30, 55 (48-60, 54) y., 93 % male) were randomly assigned to intervention group (IG n=17) or control group (CG n=13). All pts completed comprehensive 14-18 days exercise-based CR program. IG pts continue participation in 8 weeks (wks) phase III CTR program using the digital rehabilitation system, that consists of 1) smartphone application, 2) platform 3) application server, 4) data analysis server, 5) third-party tools (Polar H10 ECG belt). CTR program consisted of individualized exercise training program (aerobic and strength training), education (asynchronized lectures regarding CAD risk factors), reminders for BP monitoring, physical activity, usage of medications, physiotherapist and cardiologist remote consultations every 2-3 wks. All pts participated in a 8 wks follow-up. Main outcome measures were: 6MWD (m), heart rate reserve (HRR, %) and stride time (ST) (s) from ECG belt, questionnaires: educational CADE-Q SV, CAD self-care SC-CHDI V2.1. Pts were assessed 3 times – before (T1), after CR program (T2) and after 8 wks (T3). Mann-Whitney U and Wilcoxon test were used for statistical analysis. Results: At the baseline no statistically significant differences were observed between groups on age (IG 54 (47-61, 54) y. vs. CG 60 (48-61, 55) y., p=0.6), gender (IG were 16 (94,1 %) males vs. CG 12 (92,3 %), p=0.85). Weareble device analysis showed that ST and HRR after 8 wks statistically significantly increased only in IG (p=0.02 and p=0.04) with difference in the change between the groups (Picture 1,2). After 8 wks of CTR, the results of CADE-Q SV, SC-CHDI V2.1 questionnaires statistically significantly increased only in IG (p=0.004 and p=0.036) with statistically significantly difference between the groups (p=0.002 and p=0.004). (Table 1) The CTR was feasible and safe for the IG and no adverse effects or events occurred causing premature termination of the study. Conclusions: Study results showed that CTR helped to improve knowledge about CAD and self-care in IG. There is a tendency for better results in the IG regarding parameters from wearable devices such as HRR and ST, which implicates better physical capacity and improved mobility in CTR pt.