Key result
Planned Tele-ADHF trial tests if adding telerehabilitation to remote management improves physical capacity after ADHF.
Why the study?
Cardiac rehabilitation is under-utilised in daily practice after hospital admission for chronic heart failure, but cardiac telerehabilitation may help overcome these referral and patient-related barriers.
Does cardiac telerehabilitation combined with remote patient management improve physical functional capacity in patients recently hospitalized for acute decompensated heart failure?
RCT (n=64)
Single-blind (outcome assessor)
1:1
Yes
Does cardiac telerehabilitation combined with remote patient management improve physical functional capacity in patients recently hospitalized for acute decompensated heart failure?
This protocol describes a randomized controlled trial to evaluate the efficacy of an 18-week cardiac telerehabilitation program on physical functional capacity in patients recently hospitalized for acute decompensated heart failure.
Results from this RCT may clarify telerehabilitation value post-ADHF; leaves open current management recommendations.
Background Cardiac rehabilitation in patients with chronic heart failure (CHF) has favourable effects on exercise capacity, the risk at hospital (re-)admission and quality of life. Although cardiac rehabilitation is generally recommended it is still under-utilised in daily clinical practice, particularly in frail elderly patients after hospital admission, mainly due to low referral and patient-related barriers. Cardiac telerehabilitation (CTR) has the potential to partially solve these barriers. The purpose of this study is to evaluate the effects of CTR as compared to standard remote care after hospital admission on physical functional capacity in CHF patients. Methods In this randomised controlled trial, 64 CHF patients will be recruited during hospitalisation for acute decompensated heart failure, and randomised to CTR combined with remote patient management (RPM) or RPM alone (1:1). All participants will start with RPM after hospital discharge for early detection of deterioration, and will be up titrated to optimal medical therapy before being randomised. CTR will start after randomisation and consists of an 18-week multidisciplinary programme with exercise training by physical and occupational therapists, supported by a (remote) technology-assisted dietary intervention and mental health guiding by a physiologist. The training programme consists of three centre-based and two home-based video exercise training sessions followed by weekly video coaching. The mental health and dietary programme are executed using individual and group video sessions. A wrist-worn device enables remote coaching by the physical therapist. The web application is used for promoting self-management by the following modules: 1) goal setting, 2) progress tracking, 3) education, and 4) video and chat communication. The primary outcome measure is physical functional capacity evaluated by the Short Physical Performance Battery (SPPB) score. Secondary outcome measures include frailty scoring, recovery after submaximal exercise, subjective health status, compliance and acceptance to the rehabilitation programme, and readmission rate. Discussion The Tele-ADHF trial is the first prospective randomised controlled trial designed for evaluating the effects of a comprehensive combined RPM and CTR programme in recently hospitalised CHF patients. We hypothesize that this intervention has superior effects on physical functional capacity than RPM alone. Trial registration: Netherlands Trial Registry (NTR) NL9619, registered 21 July 2021.
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Leunen et al. (2023) conducted an RCT in Acute Decompensated Heart Failure (n=64). Cardiac telerehabilitation (CTR) combined with remote patient management (RPM) vs. Remote patient management (RPM) alone was evaluated on Physical functional capacity assessed by the Short Physical Performance Battery (SPPB) score. The Tele-ADHF trial is a planned randomized controlled trial designed to evaluate whether an 18-week cardiac telerehabilitation program combined with remote patient management improves physical functional capacity compared to remote patient management alone in 64 patients recently hospitalized for acute decompensated heart failure.
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