Applying Telemedicine in a Model of Implementing Cardiac Rehabilitation in Heart Failure Patients

Conditions

Chronic Heart Failure

Keywords

Telerehabilitation, Home Monitoring, Heart Failure

Brief summary

Applying modern technology of data collecting, monitoring, transmitting and analyzing in order to implement a novel (hybrid) model of comprehensive home-based cardiac rehabilitation in heart failure patients.

Detailed description

Heart failure (HF) epidemic is an aggressively developing phenomenon, stimulated by developing civilization and generating worrying economic and social effects. Early comprehensive cardiac rehabilitation (CCR) is an accepted method of preventing and treating adverse cardiac events, which allows for care cost reduction. In Poland, CCR availability is highly unsatisfactory (around 8%) and unacceptably varied (0.5-70%). With the existing organization and technical background, improving this situation seems impossible. Project objective: To apply telemedicine technologies to implement a novel model of home-based CCR in HF patients. The program, performed in six centers, will comprise 850 HF patients (randomization 1:1), in NYHA class I-III, EF≤40%, clinically stable, after a hospitalization incident. The study group patients will undergo a 9-week rehabilitation program consisting of two stages: Stage I - preliminary (one week at stationary ward), Stage II - main (8 weeks of home-based telerehabilitation). The primary end-point (days alive and out of hospital) will be assessed during a 24-month follow-up in both groups. The project will enable early secondary prevention in the population of people with HF to be implemented. It will be achieved via: * Novel concept - From Hospital To Home * Novel technology - telemedicine * Novel method of CCR implementation

Mierzyńska A, Jaworska I, Piotrowicz R, Kowalik I, Pencina M, Opolski G, Zareba W, Banach M, Orzechowski P, Główczynska R, Szalewska D, Pluta S, Kalarus Z, Irzmanski R, Piotrowicz E.

2023-12-182 citations

10.1007/s10880-023-09985-x

Efficacy and Safety of Hybrid Comprehensive Telerehabilitation (HCTR) for Cardiac Rehabilitation in Patients with Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Yang Z, Jia X, Li J, Mei Z, Yang L, Yan C, Han Y.

2023-08-0913 citations

10.1155/2023/5147805

Effects of hybrid comprehensive telerehabilitation on cardiopulmonary capacity in heart failure patients depending on diabetes mellitus: subanalysis of the TELEREH-HF randomized clinical trial

Renata Główczyńska, Ewa Piotrowicz, Dominika Szalewska, Ryszard Piotrowicz, Ilona Kowalik et al. (13 authors)

Cardiovascular Diabetology2021-05-1321 citations

10.1186/s12933-021-01292-9

Effects of a 9-Week Hybrid Comprehensive Telerehabilitation Program on Long-term Outcomes in Patients With Heart Failure

Ewa Piotrowicz, Michael Pencina, Grzegorz Opolski, Wojciech Zaręba, Maciej Banach et al. (17 authors)

JAMA Cardiology2019-11-17172 citations

10.1001/jamacardio.2019.5006

Interventions

OTHERhome-based telerehabilitation

Patients qualified to the study group will undergo, at five medical units a 9-week program of early hybrid, comprehensive cardiac telerehabilitation.

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

OTHER

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

* patients of either sex with any aetiology of left ventricular systolic HF \[as defined in the European Society of Cardiology (ESC) guidelines\] * with a left ventricular ejection fraction (LVEF) ≤40% on echocardiography; * in New York Heart Association (NYHA) class I, II or III; * who are to have had a hospitalization incident, be stable clinically (a patient does not need intravenous medication or has not had therapy modified for at least 7 days); * who has no contraindications to undergo cardiopulmonary exercise test and * who are able to exercise using the new model of home-based telerehabilitation.

Exclusion criteria

* NYHA class IV; * unstable angina; * unstable clinical status * a history of acute coronary syndrome within the last forty days in patients with LVEF ≤35%; percutaneous angioplasty (PCI) within the last 2 weeks, coronary artery bypass grafting within the last 3 months, or initiation of cardiac resynchronization therapy (CRT-P, CRT-D) and/or implantable cardioverter-defibrillator (ICD) or pacemaker within the last six weeks; * lack of ICD, CRT-P or CRT-D therapy despite the indications for implantation according to ESC guidelines; * intracardiac thrombus * rest heart rate (HR) \>90/min, * tachypnoea \>20 breaths per minute * symptomatic and/or exercise-induced cardiac arrhythmia or conduction disturbances; * acute myocarditis and/or pericarditis * valvular or congenital heart disease requiring surgical treatment; * hypertrophic cardiomyopathy; * severe pulmonary disease; * uncontrolled hypertension; * anemia (haemoglobin \<11.0 g/dL); * physical disability related to severe musculoskeletal or neurological problems; * recent embolism; * thrombophlebitis; * acute or chronic inflammatory disease; * acute or chronic decompensated non-cardiac diseases (thyreotoxicosis, uncontrolled diabetes) * active malignant neoplastic diseases with survival prognosis below 2 - 5 years; * orthotropic heart transplant in anamnesis; * aortic aneurysm; * severe psychiatric disorder; and * patient's refusal to participate.

Design outcomes

Primary

Measure	Time frame
days alive and out of hospital	up to 2 years

Countries

Poland

Outcome results

None listed