Quality of life in heart failure patients undergoing hybrid comprehensive telerehabilitation versus usual care – results of the Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomized Clinical Trial

Piotrowicz, Ewa; Mierzyńska, Anna; Banach, Maciej; Jaworska, Izabela; Pencina, Michał; Kowalik, Ilona; Pluta, Sławomir; Szalewska, Dominika; Opolski, Grzegorz; Zaręba, Wojciech; Główczyńska, Renata; Irzmański, Robert; Orzechowski, Piotr; Kalarus, Zbigniew; Piotrowicz, Ryszard

doi:10.5114/aoms.2020.98350

Cited by 19 publications

(14 citation statements)

References 35 publications

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“…This analysis focuses on patients randomized to the HCTR group. A total of 27 patients did not participate in HCTR program due to: technical difficulties with operating the telerehabilitation set (21), new onset of comorbidities (4), return to work (2) [17]. Finally, 398 patients started HCTR.…”

Section: Resultsmentioning

confidence: 99%

“…It concerns patients' understanding of the necessity to follow both regular exercise training and daily pharmacological treatment as well as appropriate diet and promotion of mental health. The main analysis of the entire population of TELEREH-HF RCT demonstrated that a 9-week HCTR significantly improves the physical capacity and quality of life of HF patients in contrast with the usual care [17,21]. Yet, it had no significant impact on mortality and rehospitalization rates in a long-term follow-up [17].…”

Section: Discussionmentioning

confidence: 99%

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Heart Failure Patients’ Adherence to Hybrid Comprehensive Telerehabilitation and Its Impact on Prognosis Based on Data from TELEREH-HF Randomized Clinical Trial

et al. 2022

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(1) Background Adherence to treatment guidelines in heart failure (HF) patients is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Introducing hybrid comprehensive telerehabilitation (HCTR) consisting of telecare, telerehabilitation, and remote monitoring of implantable devices might be an option to improve adherence to recommendation and can affect the prognosis. The purpose is to investigate the association of adherence to HCTR with mortality and hospitalization. (2) Methods This analysis formed part of TELEREH-HF multi-center, randomized trial that enrolled 850HF patients (NYHA I-III;LVEF ≤ 40%). Patients were randomized 1:1 to 9-week HCTR (1 week in hospital and 8 weeks at home) plus usual care or usual care only and followed-up for 14 to 26 months. This analysis focuses on the HCTR group. Adherent patients were those who adhered both to the number of training sessions prescribed and to the duration of the prescribed cycle by at least 80%; non-adherent patients were those who adhered<20% to the prescribed number of training sessions and their duration. The remaining patients were classified as partially adherent. (3) Results There were 350 (88.4%) adherent patients, 39 (9.8%) partially adherent patients, and 7 (1.8%) non-adherent patients. There were 46 deaths during follow-up. Non-adherence or partial adherence was associated with higher risk of cardiovascular (CV) mortality (hazard ratio (HR) = 2.62, p = 0.021); all-cause mortality or HF hospitalization (HR = 1.71, p = 0.038); CV mortality or HF hospitalization (HR = 1.89, p = 0.014). (4) Conclusions The adherence to HCTR was high. Adherence to HCTR was associated with improved prognosis for CV mortality and the reduction in the combined outcome of CV mortality or HF hospitalization.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Heart Failure Patients’ Adherence to Hybrid Comprehensive Telerehabilitation and Its Impact on Prognosis Based on Data from TELEREH-HF Randomized Clinical Trial

et al. 2022

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“…The question is why in our study the functional improvement after telerehabilitation did not affect the occurrence of nsVT or PVCs ≥ 10. Perhaps the period of 9 weeks of telerehabilitation is sufficient to improve physical capacity but too short to trigger the beneficial effect of long-term moderate exercise on preventing arrhythmias, particularly the improvement in autonomic balance in favor of the vagal component and the improvement in baroreflex sensitivity [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…13,14 These considerations underscore the importance of exercise training plan in terms of its type (endurance, resistance and strength), intensity (aerobic versus anaerobic); method (continuous versus intermittent/interval); setting (centre-based versus home-based); application (systemic, regional and respiratory muscle) and control (supervised versus non-supervised). 15 This highly systematic approach to training makes it safe as therapeutic strategy in HF patients.…”

Section: Heart Failure Va and The Safety Of Exercise Trainingmentioning

confidence: 99%

Antiarrhythmic effect of 9-week hybrid comprehensive telerehabilitation and its influence on cardiovascular mortality in long-term follow-up – subanalysis of the TELEREHabilitation in Heart Failure Patients randomized clinical trial

et al. 2021

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IntroductionCardiac rehabilitation is a component of heart failure (HF) management but its effect on ventricular arrhythmias is not well recognized. We analyzed the antiarrhythmic effect of a 9-week hybrid comprehensive telerehabilitation (HCTR) and its influence on long term cardiovascular mortality in HF patients taken from TELEREH-HF trial.Material and methodsWe evaluated the presence of non-sustained ventricular tachycardia (nsVT) and frequent premature ventricular complexes≥10 beats/hour (PVCs≥10) in 24-hour ECG monitoring at baseline and after 9-week HCTR or usual care(UC) of 773 HF patients (NYHA I-III, LVEF≤40%). Functional response for HCTR was assessed by changes-delta(Δ) in peak oxygen consumption(pVO2) as a result of comparing pVO2 from the beginning and the end of the program.ResultsAmong 143 patients with nsVT, arrhythmia subsided in 30.8% after HCTR, similarly among 165 patients randomized to UC who had nsVT 34.5% did not show them after 9 weeks (p=0.481). There was no significant difference in the decrease in PVC≥10 over 9 weeks between randomization arms (14.9%vs17.8%, respectively p=0.410). Functional response for HCTR in ΔpVO2>2.0 ml/kg/min did not affect occurrence of arrhythmias. Multivariable analysis did not identify HCTR as an independent factor determining improvement of nsVT or PVCs≥10. However, only in HCTR group, the achievement of the antiarrhythmic effect significantly reduced the cardiovascular mortality in 2-year follow-up (p<0.001).ConclusionsSignificant improvement in physical capacity after 9 weeks of HCTR did not correlate with the antiarrhythmic effect in terms of incidence of nsVT or PVCs≥10. An antiarrhythmic effect after the 9-week HCTR affected long term cardiovascular mortality in HF patients.

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“…This association may be due to a decrease in the left ventricular volume overload [ 26 ]. Furthermore, cardiac rehabilitation may be associated with improvement in exercise tolerance in patients with HF (reduction in NYHA class, improvement in peak oxygen consumption and an increase in the distance during the six-minute walk test) and improvement in three specific areas of quality of life: physical functioning, role functioning related to physical state and bodily pain [ 17 , 27 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Remote Monitoring of Cardiac Implantable Electronic Devices in Patients Undergoing Hybrid Comprehensive Telerehabilitation in Comparison to the Usual Care. Subanalysis from Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomised Clinical Trial

Pluta

Piotrowicz

et al. 2020

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Background: The impact of cardiac rehabilitation on the number of alerts in patients with remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) is unknown. We compared alerts in RM and outcomes in patients with CIEDs undergoing hybrid comprehensive telerehabilitation (HCTR) versus usual care (UC). Methods: Patients with heart failure (HF) after a hospitalization due to worsening HF within the last 6 months (New York Heart Association (NYHA) class I-III and left ventricular ejection fraction (LVEF) ≤40%) were enrolled in the TELEREH-HF study and randomised 1:1 to HCTR or UC. Patients with HCTR and CIEDs received RM (HCTR-RM). Patients with UC and CIEDs were offered RM optionally (UC-RM). Data from the initial 9 weeks of the study were analysed. Results: Of 850 enrolled patients, 208 were in the HCTR-RM group and 62 in the UC-RM group. The HCTR-RM group was less likely to have alerts of intrathoracic impedance (TI) decrease (p < 0.001), atrial fibrillation (AF) occurrence (p = 0.031) and lower mean number of alerts per patient associated with TI decrease (p < 0.0001) and AF (p = 0.019) than the UC-RM group. HCTR significantly decreased the occurrence of alerts in RM of CIEDs, 0.360 (95%CI, 0.189–0.686; p = 0.002), in multivariable regression analysis. There were two deaths in the HCTR-RM group (0.96%) and no deaths in the UC-RM group (p = 1.0). There were no differences in the number of hospitalised patients between the HCTR-RM and UC-RM group (p = 1.0). Conclusions: HCTR significantly reduced the number of patients with RM alerts of CIEDs related to TI decrease and AF occurrence. There were no differences in mortality or hospitalisation rates between HCTR-RM and UC-RM groups.

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Quality of life in heart failure patients undergoing hybrid comprehensive telerehabilitation versus usual care – results of the Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomized Clinical Trial

Cited by 19 publications

References 35 publications

Heart Failure Patients’ Adherence to Hybrid Comprehensive Telerehabilitation and Its Impact on Prognosis Based on Data from TELEREH-HF Randomized Clinical Trial

Heart Failure Patients’ Adherence to Hybrid Comprehensive Telerehabilitation and Its Impact on Prognosis Based on Data from TELEREH-HF Randomized Clinical Trial

Antiarrhythmic effect of 9-week hybrid comprehensive telerehabilitation and its influence on cardiovascular mortality in long-term follow-up – subanalysis of the TELEREHabilitation in Heart Failure Patients randomized clinical trial

Remote Monitoring of Cardiac Implantable Electronic Devices in Patients Undergoing Hybrid Comprehensive Telerehabilitation in Comparison to the Usual Care. Subanalysis from Telerehabilitation in Heart Failure Patients (TELEREH-HF) Randomised Clinical Trial

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