A randomized controlled clinical trial of cardiac telerehabilitation with a prolonged mobile care monitoring strategy after an acute coronary syndrome

Abstract

Background: Center-based cardiac rehabilitation (CBCR) improves health outcomes but has some limitations. We designed and validated a telerehabilitation system to overcome these barriers. Methods:We included 67 low-risk acute coronary syndrome patients in a randomized controlled trial allocated 1:1 to a 10-month cardiac telerehabilitation (CTR)program or an 8-week CBCR program. Patients underwent ergospirometry, blood tests, anthropometric measurements, IPAQ, PREDIMED, HADS, and EQ-5D questionnaires at baseline and 10 months. Data collectors were blinded to the treatment groups.Results: The intention-to-treat analysis included 31 patients in the CTR group and 28 patients in the CBCR group. The primary outcome showed increased physical activity according to the IPAQ survey in the CTR group compared to the CBCR group (median increase 1726 METS-min/week vs. 636, p = .045). Mean VO2max increased 1.62 ml/(kg min) (95% confidence interval [CI]: 0.56-2.69, p < .004) from baseline in the CTR group, and 0.60 mL/(kg min) (p = .40) in the CBCR group. Mean apoB/apoA-I ratio decreased 0.13 (95% CI: −0.03 to 0.24, p = .017) in the CTR group, with no significant change in the CBCR group (p = .092). The median non-HDL cholesterol increased by 7.3 mg/dl (IQR: −2.4 to 18.6, p = .021) in the CBCR group, but the increase was not significant in the CTR group (p = .080). Adherence to a Mediterranean diet, psychological distress, and quality of life showed greater improvement in the CTR group than in the CBCR group. Return-to-work time was reduced with the telerehabilitation strategy. Conclusion:This system allows minimal in-hospital training and prolonged follow-up. This strategy showed better results than CBCR.

Cardiac telerehabilitation with long-term follow-up reduces GlycA and improves lipoprotein particle profile: A randomised controlled trial

“…Although 67 patients were enrolled in the study, only 59 were included in the intention-to-treat analysis; 31 and 28 patients were randomised to the CTR and CBCR groups, respectively. Among them, 56 had full blood test results (31 patients in the CTR group and 25 patients in the CBCR group); no differences were observed at baseline between groups [1]. At ten months, GlycA only significantly decreased in the CTR group (p = 0.007), with borderline significant differences observed when compared with the CBCR group (p = 0.074) (Fig.…”

“…These findings were mainly related to physical activity maintenance during the 10-month follow-up, with improved oxygen consumption, and higher adherence to the Mediterranean diet. Other benefits already published were less psychological distress, better quality of life, and early return to work [1]. 1 H NMR based on GlycA shows lower inter-individual variability, and lower punctual fluctuations associated with acute inflammatory processes not necessarily related to subclinical atherosclerosis [8].…”

“…Other benefits already published were less psychological distress, better quality of life, and early return to work [1]. 1 H NMR based on GlycA shows lower inter-individual variability, and lower punctual fluctuations associated with acute inflammatory processes not necessarily related to subclinical atherosclerosis [8]. Therefore, GlycA can improve the predictive outcomes of CRP in patients with CHD [10].…”

“…If the LDL level exceeded 100 mg/dL at 4 months, the treatment was modified, and the patient was excluded from the lipid sub-study. The details and results of this trial were recently published [1].…”

“…We recently demonstrated that a 10-month extended follow-up strategy of cardiac telerehabilitation (CTR) achieved better outcomes than a standard, centre-based cardiac rehabilitation (CBCR) programme; particularly, improvements in the apoB/apoA-1 ratio and non-highdensity lipoprotein (HDL) cholesterol levels were observed [1]. Lowdensity lipoprotein (LDL) cholesterol is conventionally regarded as the most relevant biomarker for coronary heart disease (CHD); however, increased remnant cholesterol and qualitative alterations in lipoprotein particles are associated with residual risk and low-grade inflammation [2].…”