Effectiveness of Home-Based Cardiac Telerehabilitation on Adherence of Patients After Percutaneous Coronary Intervention in Indonesia (HBECTR Study)

Intervention Group (IG) The treatment group will receive Home-based exercise cardiac telerehabilitation (HBECTR). We define HBECTR as an exercise-based cardiac rehabilitation (EBCR) conducted in a hybrid setting, both in the hospital and at the patient's home, supported by a telemonitoring system. In hospital, subject will do face to face exercise at CR center Dr. Sardjito General Hospital Indonesia, while at home subject will do walking exercise supported by telemonitoring system (App Rehab Cardio). The cardiologist will prescribe an exercise regimen individualized for each patient based on their baseline six-minute walk test (6MWT) results. The exercise program will follow the FITT principle—Frequency, Intensity, Time, and Type. Target heart rate (HR) and walking distance will be determined according to the patient’s baseline 6MWT performance, with exercise intensity progressively increased on a weekly basis if tolerated. Frequency: 5 session per week, divided into: 2 session/week at hospital and 3 session/week at home (20 sessions over 4 weeks in total) Intensity: Moderate Time: 45 minutes (Warm-up: 5 minutes; Core-exercise: 30 minutes; Cool-down: 10 minutes) Type: Aerobic (Hospital: ergo cycle and treadmill; Home: walking on flat ground) Monitoring: a. Hospital: supervised by Cardiac rehab (CR) Nurse based on HR, BP, SaO2, distance, RPE and % HRR b. home: monitored by smart watch connected to dashboard (App Rehab Cardio), based on HR, BP, SaO2, walking distance, and patients complain Real-time Monitoring During exercise at home, subjects will be monitored by a nurse remotely trough a telemonitoring (TEKAD). With high-precision sensors, the smartwatch “covwatch” will continuously tracks the patient’s heart rate, blood pressure, oxygen saturation level during exercise, and estimated walking distance. The system is connected via internet to the dashboard (App Rehab Cardio). Exercise education and exercise guidance book designed by the researchers specifically for this study will be provided before the program begins. The Cardiologist and cardiac rehab (CR) Nurse will educate the subjects about the urgency of exercise for post PCI patients, the prescribed exercise, and how to do exercise both in hospital and at home. The subjects also will be informed about the signs and symptoms of cardiovascular emergencies, both during exercise at hospital and at home, such as chest pain, palpitation, shortness of breath, etc. A guidebook is provided for patients, which details how to perform exercises safely at home and how to use the smartwatch for monitoring. The exercise education will be conducted in person via verbal discussion at the CR center of Dr. Sardjito General Hospital. Both groups will be recruited by consecutive sampling, where the intervention group will be recruited and completed follow-up before initiation of the control/comparison group.