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Home-Based Mobile Guided Cardiac Rehabilitation for Elderly Patients
Quick Takes
- Cardiac rehabilitation delivered in a patient’s home via telemonitoring and coaching calls is effective for improving physical fitness among older adults with cardiac conditions.
- Home-based cardiac rehabilitation appears to be safe.
- Home-based cardiac rehabilitation programs may be important for cardiac patients residing in areas where access to center-based programs is limited.
Study Questions:
Is a 6-month guided mobile cardiac rehabilitation (CR) program effective for elderly patients who decline to participate in traditional CR?
Methods:
The investigators used a parallel multicenter randomized controlled trial to examine the efficacy of a mobile health delivered CR program among a population of elderly adults. Participants were enrolled between November 2015 and January 2018. Follow-up was completed in January 2019. Patients with a recent diagnosis of acute coronary syndrome, coronary revascularization, or surgical or percutaneous treatment for valvular disease, or documented coronary artery disease from six cardiac institutions across five European countries were identified. Patients who declined to start traditional CR and met eligibility criteria were randomized to either 6 months of home-based (i.e., mobile CR) with telemonitoring and coached-based motivational interviewing or usual care, who did not receive any CR during the study period. The primary outcome was peak oxygen uptake (VO2peak) after 6 months.
Results:
Of the 4,236 patients identified, 996 declined to start CR, and of these, 179 (145 male, median age 72 years) met the study eligibility criteria and were enrolled in the ER-CaRE (European Study on Effectiveness and Sustainability of Current Cardiac Rehabilitation Programmes in the Elderly) trial. A total of 159 participants (89%) were eligible for the primary endpoint analysis, and 151 participants completed follow-up at 1 year. VO2peak improved in the mobile CR group (n = 89) at 6 months (1.6; 95% confidence interval [CI], 0.9-2.4 ml/kg−1/min−1) and at 12 months (1.2; 95% CI, 0.4-2.0 ml/kg−1/min−1). No improvement was noted in the control group (n = 90) at 6 months (+0.2; 95% CI, −0.4 to 0.8 ml/kg−1/min−1) and at 1 year (+0.1; 95% CI, −0.5 to 0.7 ml/kg−1/min−1). Changes in VO2peak were greater in the mobile CR versus control groups at 6 months (+1.2; 95% CI, 0.2-2.1 VO2peak) and 12 months (+0.9; 95% CI, 0.05-1.8 VO2peak). The incidence of adverse events was low and did not differ between the mobile CR and control groups.
Conclusions:
These data suggest that a 6-month home-based mobile CR program for patients ages ≥65 years with coronary artery disease or a valvular intervention was safe and beneficial in improving VO2peak when compared with no cardiac rehabilitation.
Perspective:
Participation in center-based CR is low; thus, finding alternative strategies to reduce barriers to participants in CR are warranted. This study observed increases in physical fitness with a mobile CR, which were significantly greater than no CR. However, large numbers of patients who declined center-based CR also declined to participate in this study, suggesting that additional research is needed to find programs acceptable to cardiac patients.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Sports and Exercise Cardiology, Valvular Heart Disease, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Structural Heart Disease
Keywords: Acute Coronary Syndrome, Cardiac Surgical Procedures, Cardiac Rehabilitation, Coronary Artery Disease, Geriatrics, Heart Valve Diseases, Motivational Interviewing, Myocardial Revascularization, Oxygen Consumption, Physical Fitness, Primary Prevention, Telemedicine, Transcatheter Aortic Valve Replacement
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