Efficacy and safety of digital therapeutics‐based cardiac rehabilitation in heart failure patients: a systematic review

Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, it has become difficult to provide centre-based cardiac rehabilitation for heart failure patients. Digital therapeutics is a novel concept proposed in recent years that refers to the use of evidence-based therapeutic interventions driven by high-quality software programs to treat, manage, or prevent a medical condition. However, little is known about the use of this technology in heart failure patients. This study aims to explore the safety and efficacy of digital therapeutics-based cardiac rehabilitation in heart failure patients and to provide new insights into a new cardiac rehabilitation model during the COVID-19 era. To identify technologies related to digital therapeutics, such as the use of medical applications, wearable devices, and the Internet, all relevant studies published on PubMed, EMBASE, Cochrane database, and China National Knowledge Internet were searched from the time the database was established until October 2021. The PEDro was used to assess the quality of included studies. We ultimately identified five studies, which included 1119 patients. The mean age was 66.37, the mean BMI was 25.9, and the NYHA classification ranged from I to III (I = 232, II = 157, III = 209). The mean 6-min walk distance was 397.7 m. The PEDro scores included in the study ranged from 4 to 8, with a mean of 5.8. Exercise training was performed in four studies, and psychological interventions were conducted in three studies. No death or serious adverse events were observed. Adherence was reported in three studies, and all exceeded 85%. The results of most studies showed that digital therapeutics-based cardiac rehabilitation significantly increases exercise capacity and quality of life in heart failure patients. Overall, although this study suggests that digital therapeutics-based cardiac rehabilitation may be a viable intervention for heart failure patients during the COVID-19 era, the efficacy of this new model in routine clinical practice needs to be further validated in a large clinical trial.

Digital Therapeutics as a New Therapeutic Modality: A Review from the Perspective of Clinical Pharmacology

“…From the initial idea of digitalizing CBT, DTx have evolved and continue to expand the range of embedded digital interventions and targeted areas. In Table 1 we compiled a nonexhaustive list of references across a variety of indications where DTx are currently developed, used or foreseen to play a key role for patients 2–41 . This illustrates why their development is associated with significant promise, in particular for tackling the continuously growing burden of chronic diseases 42 …”

Cardiac Rehabilitation in the Modern Era: Optimizing Recovery and Reducing Recurrence

“…Cardiologists are responsible for the supervision of medical management. At the same time, nurses are tasked with monitoring vital signs and administering drugs [ 21 ]. Dietitians assess individuals' dietary patterns and recommend promoting cardiovascular health through nutrition.…”

“…Social assessments examine the patient's social support network, familial interactions, socioeconomic standing, and healthcare accessibility. Several factors can impact patients' capacity to alter their lifestyles and adhere to rehabilitation programs [ 21 ]. Healthcare providers can provide customized support and resources by gaining awareness of the social environment of their patients.…”

“…The use of stretching exercises that specifically target the major muscle groups is recommended as part of the rehabilitation regimen. The process of prescribing exercise in cardiac rehabilitation necessitates tailoring the regimen to the unique characteristics of each patient, including their clinical condition, risk factors, comorbidities, and capacity for physical activity [ 21 ]. Risk stratification methods, such as the Duke Treadmill Score and the Seattle Heart Failure Model, can be utilized to classify patients into different risk groups, which can then inform the appropriate level of intensity and monitoring for exercise sessions.…”

Effects of home-based cardiac telerehabilitation programs in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis

“…The use of telehealth has grown tremendously and covers a wide range of content, such as digital information collection, precision medicine, virtual diagnosis, and treatment. Compared to other telehealth interventions, HBCTR focuses on the rehabilitation and prognosis of heart disease patients, and the core components of management include exercise training, risk factor control, psychological counseling, drug guidance, and nutritional prescription [ 22 , 23 ]. The based model established by HBCTR is: the doctors formulate the CR prescription and send it remotely, and the patients execute the prescription, report data and conduct follow-up feedback, after that doctors make the personalized modification of the rehabilitation prescription in the standardized medical behavior.…”