Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial

Abstract

REMOTE-CR is an effective, cost-efficient alternative delivery model that could-as a complement to existing services-improve overall utilisation rates by increasing reach and satisfying unique participant preferences.

Heartbeat: Time to switch from aortic valve area to aortic valve index?

“…In a randomised study of standard CR versus remotely-monitored CR, the telemedicine approach was non-inferior to the standard CR approach as assessed by exercise status, maximum oxygen consumption, and waist and hip circumference at completion of the programme (figure 4). 6 Programme and medication costs were lower for the telemedicine CR with no difference in hospitalisation costs. Lavie, Kachur and Milani7 congratulate the authors on this study and comment that “Certainly, more comprehensive Remote-CR models, including home, internet and community-based programmes, are needed to provide alternatives to conventional, medically supervised, facility-based Standard-CR.…”

Future-proofing cardiac rehabilitation: Transitioning services to telehealth during COVID-19

“…However, it must be mentioned that there is much more to learn about what makes mHealth applications appealing and how these interventions can be used for long-term cardiovascular disease management. 3 Videoconferencing offers the additional advantage of enabling providers to see and hear their patients (and vice versa); it can enable you to develop a therapeutic rapport, get a sense of a patient's health and well-being, supervise exercise remotely (either through videoconferencing software demonstrated by Hwang et al 4 or via a bespoke telerehabilitation platform and remote monitoring devices demonstrated by Maddison et al 5 ) and provide feedback and support, as well as share screens and files for educational and counselling purposes and to illustrate required actions. Videoconferencing also allows for groups, 3 therefore enhancing efficiency and providing the opportunity for participants to share experiences.…”

Making cardiac rehabilitation more available and affordable

“…Therefore, although the improvements in psychological risk factors were correlated with improvements in exercise capacity, nevertheless, all patients also received the other non-exercise aspects of Standard-CR. Whether all of the benefits would be similar to Remote-CR was not assessed in the Maddison et al ’s5 study, but at least we know HRQoL did at least improve similarly to that with Standard-CR.…”

“…In their Heart paper, Maddison and colleagues5 from Australia and New Zealand report on a randomised controlled trial of CRET, with telerehabilitation (Remote-CR) and centre-based CRET (Standard-CR) in 162 participants, where exercise capacity or peak oxygen consumption (peak VO 2 ), CHD risk factors, exercise adherence, motivation, HRQoL, and interventions, hospital utilisations and medication costs were all assessed and compared in both groups. After completion of both programmes, most parameters, importantly peak VO 2 , were similar in both groups, whereas waist and hip circumference was lower in Standard-CR, and Remote-CR patients were less sedentary at 24 weeks.…”

“…The time has come to ‘re-brand and re-invigorate’ CR 1 3. We congratulate Maddison and colleagues5 for providing a good step in the right direction regarding making CRET programmes more available and affordable in the current era.…”