Telerehabilitation in heart failure patients: The evidence and the pitfalls

Piotrowicz, Ewa; Piepoli, Massimo F; Jaarsma, Tiny; Lambrinou, Ekaterini; Coats, Andrew J.S.; Schmid, Jean Paul; Corrà, Ugo; Agostoni, Piergiuseppe; Dickstein, Kenneth; Seferović, Petar; Adamopoulos, Stamatis; Ponikowski, Piotr

doi:10.1016/j.ijcard.2016.06.277

Cited by 83 publications

(75 citation statements)

References 53 publications

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“…In this context, telerehabilitation has been advocated by some authors as a way to improve adherence and a practical way to promote regular exercise training in stable HF patients. 40 One randomised trial on telerehabilitation in HF patients…”

Section: Hf-related Hospitalisations the Recent Better Effectivenessmentioning

confidence: 99%

Value of Telemonitoring and Telemedicine in Heart Failure Management

Gensini

Alderighi²,

Rasoini³

et al. 2017

Cardiac Failure Review

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DevicesAccess at: www. CFRjournal.com Telehealth is a multiform term embracing the applications of telematics to medicine, in order to enable diagnosis and/or treatment remotely through a set of communication tools, including phones, smartphones and mobile wireless devices, with or without a video connection.1 Until a few years ago, digital applications in medicine were restricted to the use of data obtained from electronic health records (EHR), but, in more recent times, the technological context has notably expanded: the number of existing internet-connected mobile devices has roughly doubled every five years. This phenomenon will probably lead to the simultaneous operability of around 50 billion devices by 2020. 2 SensorsSensors are tools that are capable of detecting, recording and responding to specific inputs coming from a physical setting (e.g. a patient's vital signs) and are increasingly embedded in smartphones and other mobile devices. Recording and quantifying biological variables by means of sensors is generating large digital datasets that are suitable for transmission in real-time to healthcare and non-healthcare professionals. Computer applications arising from these phenomena are potentially numberless and will probably drive changes in both doctor-patient relationships and healthcare economic scenarios. Several insurance companies have already introduced better money premiums for customers who demonstrate regular use of smartphone applications aimed at illness prevention. 1 Some issues that will need to be addressed in the near future concern patient privacy and data safety. 3 As the practice of selling personal data to third parties for commercial purposes has come to light, increased attention has focused on data security of digital platforms and mobile devices. 4,5 Several reports published recently have revealed a concerning lack of details regarding the way that personal data is managed by telehealth application developers. 5 TheGlobal Privacy Enforcement Network has disclosed that around 60 % of the applications they evaluated exhibited criticisms regarding privacy issues, as they did not properly inform users how their personal data would be used and the number of personal questions asked was considered inappropriate. 6 Heart Failure EpidemiologyHeart failure (HF) is a common clinical syndrome associated with high morbidity and mortality. It is a major public health problem, with a prevalence of over 5.8 million people affected in the US, and over 26 million people worldwide. 7 In the US and in Europe, HF prevalence ranges from 1.1 % to 2.2 % in the general population. Most of the HF burden is situated in people aged over 65 years, who account for more than 80 % of deaths and prevalent cases in the US and in Europe. 8,9The lifetime probability of developing HF is believed to be one in five.Notwithstanding the historical equation that attributes HF genesis to a reduced left ventricular ejection fraction (LVEF), it has been shown that, in real medical practice, HF with preserved LVEF is ...

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Section: Hf-related Hospitalisations the Recent Better Effectivenessmentioning

confidence: 99%

Value of Telemonitoring and Telemedicine in Heart Failure Management

Gensini

Alderighi²,

Rasoini³

et al. 2017

Cardiac Failure Review

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“…An interesting trial (Palliative Care in Heart Failure) is in progress to explore the impact of interdisciplinary palliative care in patients with end-stage heart failure and may in due course guide further refinements of how and when palliative care is delivered in that situation [107]. Pending the results of this and other research [108][109][110][111][112], physicians treating patients with endstage heart failure should adhere as closely as possible to extant ethical recommendations.…”

Section: Shared Decision Making Is the Process Through Which Cliniciamentioning

confidence: 99%

Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations

Fruhwald

Pollesello

Fruhwald

2016

Expert Review of Cardiovascular Therapy

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The later stages of heart failure are characterized by a steady decline in quality of life. Clinical priorities should be to maintain functional capacity and quality of life. In the absence of sufficient organs for transplantation, options include left ventricular assist devices and inotropic support. Areas covered: We examined data published in the last two decades on the use of inotropes and inodilators in advanced heart failure. Expert commentary: In the literature, use of conventional inotropes, including adrenergic agonists and phosphodiesterase inhibitors, appears to be suboptimal for achieving the clinical priorities of late-stage heart failure. Evidence suggests instead that the calcium-sensitizing inodilator levosimendan, administered intermittently, delivers improvements in functional capacity and quality of life and does so with no adverse impact on life expectancy. At a terminal or near-terminal stage of heart failure, the therapeutic philosophy should shift towards meeting patients' existential priorities rather than traditional heart failure-centric targets.

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“…To summarise, telemonitoring can be used to monitor patient's physiological status (heart rate, blood pressure and weight) and clinical symptoms (chest pain, dyspnoea and oedema) at home via external monitoring devices or implantable cardiovascular devices, and thereby identify deteriorations in health (Chaudhry et al, 2007); telecoaching can be used to provide in-home support or advice on risk factor modifications via motivational text messaging (Chow et al, 2015;Frederix et al, 2015a) and coaching sessions over the telephone (Piamjariyakul et al, 2013); and telerehabilitation can be used to deliver rehabilitation services across a distance via telecommunication technologies (Frederix et al, 2015b;Holland & Cox, 2017;Piotrowicz et al, 2016a) such as online videoconferencing.…”

Section: Chapter 7 Discussionmentioning

confidence: 99%

“…On the other hand, a laptop computer or a tablet may offer less audiovisual clarity, but can suit a heart failure telerehabilitation program due to its portability, easy setup and wide availability. When considering monitoring equipment, some peripheral devices offer wireless Bluetooth capability (Piotrowicz et al, 2016a), which makes it easier to transmit data, but adds to the cost. Third, choose an appropriate software platform to deliver the telerehabilitation program.…”

mentioning

confidence: 99%

Providing Heart Failure Rehabilitation in the Home via Telerehabilitation

Hwang

Bruning

Mandrusiak

et al. 2016

Heart, Lung and Circulation

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Exercise is effective for patients with chronic heart failure (CHF). Despite this, many patients are unable to access traditional exercise-based rehabilitation programs for various reasons, such as transport difficulties and program availability. Telerehabilitation, in which telecommunication technologies are used to provide rehabilitation at a distance, is an alternative approach which may overcome some of these barriers.The current literature suggests that telerehabilitation is effective in patients with cardiopulmonary diseases. However the majority of studies focus on phone-based interventions, so there is a need for more studies on the use of video-based telerehabilitation programs. Video-based telerehabilitation is a new approach which enables patients to exercise in the comfort of their homes, whilst maintaining synchronous audiovisual communication. This approach enables the clinician to watch patients performing the exercises and to provide real-time feedback and modification as required, as well as facilitate the development of rapport between the clinician and patients, and peer support amongst patients. Video-based telerehabilitation also presents a potential way to conduct remote assessment of functional exercise capacity.This thesis aimed to explore a new service delivery model for providing heart failure exercise-based rehabilitation programs. The thesis commences with a systematic review of telerehabilitation in patients with cardiopulmonary diseases (Study 1, Paper 1). The next study aimed to determine the suitability of the timed up and go test (TUGT) as an outcome measurement in heart failure rehabilitation programs (Study 2, Paper 2). In addition, the validity and reliability of telerehabilitation assessments of functional tests including the TUGT were examined in patients with CHF (Study 3, Paper 3). A randomised controlled trial determined the feasibility and effectiveness of a home-based heart failure telerehabilitation program compared with a traditional centre-based program (Study 4, Paper 4). A mixed methods study was also conducted to determine patient experiences and perspectives related to a heart failure telerehabilitation program (Study 5, Paper 5).Based on the systematic review of 11 studies, telerehabilitation appears to be a promising alternative to traditional centre-based programs in patients with cardiopulmonary diseases. In particular, telerehabilitation has been shown to improve exercise capacity and quality of life in these patient groups and has higher adherence rates compared with traditional centre-based programs.iii However, suitable outcome measures that can be administered via telerehabilitation are required. A possible outcome measure is the TUGT, which is a quick and easy-to-administer functional test.However prior to using the TUGT as an outcome measure in telerehabilitation studies, it was first important to validate its use in both face-to-face and telerehabilitation environments. The TUGT demonstrated excellent test-retest reliability in patients with C...

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Telerehabilitation in heart failure patients: The evidence and the pitfalls

Cited by 83 publications

References 53 publications

Value of Telemonitoring and Telemedicine in Heart Failure Management

Value of Telemonitoring and Telemedicine in Heart Failure Management

Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations

Providing Heart Failure Rehabilitation in the Home via Telerehabilitation

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