Methods:

A cost-utility analysis of data from a randomized clinical trial of 3 months of CTR followed by 9 months of relapse prevention was compared with the cost-effectiveness of traditional center-based CR serving two hospitals in the Netherlands. The analysis included 300 patients entering phase 2 who were referred for CR including stable CAD, and patients following an acute coronary syndrome and/or coronary revascularization. After baseline measurements, patients were randomly allocated on a 1:1 ratio to receive CTR (intervention group) or center-based CR (control group). The exercise training was standard in both groups with number of sessions and intensity tailored depending on need. Other core components including psychological counseling was provided to both groups. Those allocated to the CTR intervention group received access to a web-based application and were provided with a wrist-worn heart rate monitor and a hip-worn triaxial accelerometer. The exercise training module began with six supervised group-based sessions. Exercise training was then continued at home unless the patient preferred otherwise. Weekly video consultations with the physical therapist through the web-based application were scheduled until individual goals were achieved or the program was completed and evaluated. Patients in the intervention group uploaded sensor data to the web-based application at least once per week and reviewed these data during video consultations. Weekly telemonitoring guidance was concluded after 3 months; patients were then instructed to continue using their sensors and uploading data until study completion after 12 months. For this novel extension comprising on-demand coaching, the investigator evaluated sensor data every 4 weeks until study completion and notified the patient’s physical therapist when predefined relapses occurred.