Effects of cardiac telerehabilitation during COVID-19 on cardiac hemodynamic and functional responses and quality of life: a randomized controlled trial

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Coronary artery disease following percutaneous coronary intervention (PCI) (n=80). Intervention: Home-based cardiac telerehabilitation (HBCT) vs. Routine care / unsupervised exercise recommendation (physician recommendation to walk 30-40 min five times a week without supervised exercise training) plus usual medications. Primary outcome: Distance walked on modified Bruce treadmill test (m) at 8 weeks (p=0.019).

Q: What does this research mean for the field?

An 8-week home-based cardiac telerehabilitation program significantly improves exercise capacity, left ventricular ejection fraction, hemodynamic parameters, and health-related quality of life in post-PCI patients. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mostafa Dehghani; Mostafa Cheraghi; Amir Shakarami; Morteza Dehghani; Mehrdad Namdari

doi:10.1097/ms9.0000000000002235

October 1, 2024Annals of Medicine and SurgeryOpen Access

Effects of cardiac telerehabilitation during COVID-19 on cardiac hemodynamic and functional responses and quality of life: a randomized controlled trial

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Key result

Home-based cardiac telerehabilitation increases walking distance by ~147 m vs. control in post-PCI patients.

P=0.019
n=80

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Why the study?

The effects of home-based cardiac telerehabilitation on cardiac hemodynamic and functional responses and quality of life in patients undergoing PCI were assessed.

Does an 8-week home-based cardiac telerehabilitation program improve cardiac hemodynamic parameters, functional capacity, and health-related quality of life compared to unsupervised exercise recommendations in patients with coronary artery disease following PCI?

Key Points

To assess the effects of an 8-week home-based cardiac telerehabilitation program on cardiac hemodynamic and functional responses and health-related quality of life in patients undergoing percutaneous coronary intervention.
Single-blinded randomized controlled clinical trial of patients who underwent percutaneous coronary intervention (mean age: 50.41±7.3 years).
Participants were randomized to an intervention group receiving an 8-week home-based telerehabilitation program (supervised exercise training, walking, phone calls, and a pedometer) or a control group.
Compared with controls, the intervention group showed significant reductions in resting systolic blood pressure (126.82±9.17 vs. 131.27±10.24 mmHg; P=0.044), resting diastolic blood pressure (87.4±5.39 vs. 89.17±7.33 mmHg; P=0.027), resting heart rate (76.15±3.01 vs. 77.65±4.16 beats/min; P=0.041), maximum heart rate (143.1±5.24 vs. 147.57±8.63 beats/min; P=0.011), and rate pressure product (9.64±0.81 vs. 10.07±0.99; P=0.007).
The intervention group achieved significant increases in ejection fraction (45.75±4.31 vs. 43.5±5.21%; P=0.039), distance walked (514.95±214.5 vs. 368.04±221.43 m; P=0.019), and metabolic equivalents (7.41±0.84 vs. 6.89±1.28; P=0.018).
Health-related quality of life was significantly higher in the intervention group for both the mental component score (50.62±10.45 vs. 46.25±7.74; P=0.037) and physical component score (46.75±8.73 vs. 42.37±9.99; P=0.040), with zero adverse events recorded during exercise.

Study Design

Type

RCT (n=80)

Blinding

Single-blind

Randomization

Permuted block randomization (1:1 allocation ratio, block sizes 3, 6, and 4)

Multicenter

No

Structured PICO

Does an 8-week home-based cardiac telerehabilitation program improve cardiac hemodynamic parameters, functional capacity, and health-related quality of life compared to unsupervised exercise recommendations in patients with coronary artery disease following PCI?

P

Population

80 urban adults (aged 45-60 years, 51.25% female) with coronary artery disease, LVEF 30-50%, and NYHA class II-III who underwent PCI at least 2 months prior, followed for 8 weeks.

I

Intervention

Home-based cardiac telerehabilitation (HBCT) for 8 weeks (40 scheduled sessions; 50 min per session including 10-min warm-up, 30-min aerobic walking using a pedometer starting at 3000 steps/day and increasing by 15% weekly up to 8250 steps/day at 70-85% heart rate, and 10-min cool-down), accompanied by twice-weekly 4-6 min supervised exercise calls by a CR physician, weekly educational sessions, psychological/nutritional/smoking cessation consultations, and usual medications.

C

Comparator

Control group receiving physician recommendation to walk 30-40 minutes five times a week at the same frequency and intensity but without supervised exercise training, alongside usual medications.

O

Outcome

Cardiac hemodynamic responses (resting SBP, resting DBP, resting HR, maximum HR, LVEF, and rate pressure product [RPP]), functional capacity (treadmill distance walked and metabolic equivalents [METs] via modified Bruce protocol), and health-related quality of life (SF-36 physical component summary [PCS] and mental component summary [MCS]) at 8 weeks.surrogate

Main Result

Absolute Event Rate: 514.95% vs 368.04%

p-value: p=0.019

An 8-week supervised home-based cardiac telerehabilitation program utilizing pedometers and telephone follow-ups is a safe and effective alternative to improve hemodynamics, exercise capacity, and quality of life in post-PCI patients when center-based rehabilitation is unavailable.

Limitations

Lack of assessment of systemic inflammatory markers, which generally elevate after PCI
LV diastolic filling assessed by transmitral Echo-Doppler could have been influenced by confounding factors such as heart rate, loading conditions, and valvular insufficiency
Conducted in a single urban region, limiting generalizability to other populations
Lack of assessment of systemic inflammatory markers which generally elevate after PCI
LV diastolic filling pathways assessed by transmitral Echo-Doppler could have been influenced by heart rate, cardiac conduction, loading conditions, valvular insufficiency, transmitral pressure gradient, and myocardial viscoelastic properties
Study was conducted in a single urban region, limiting generalizability to other populations

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Implication

Supports home-based telerehabilitation as alternative post-PCI when center-based unavailable; extends RCT evidence for functional capacity and LVEF gains.

Abstract

Purpose: This study aimed to assess the effects of a home-based cardiac telerehabilitation (HBCT) on cardiac hemodynamic and functional responses and health-related quality (HRQOL) of the patients undergoing percutaneous coronary intervention (PCI). Materials and methods: In this randomized controlled clinical trial, single-blinded. One hundred-fifty-five patients (mean age: 50.41±7.3 years, 41 women and 39 men) who underwent PCI were randomized into the two groups of intervention and control. The HBCT program included supervised exercise training, walking, phone calls, and a pedometer for 8 weeks. Hemodynamic changes, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), resting heart rate (HR rest ), maximum heart rate (HR max ), ejection fraction (EF), and rate pressure product (RPP), and functional parameters including the distance walked and metabolic equivalents (METS), also HRQOL were measured in all patients before and after the 8-week HBCT program. Results: Our results showed significant reductions in SBP rest (126.82±9.17 vs. 131.27±10.24; P =0.044), DBP rest (87.4±5.39 vs. 89.17±7.33; P =0.027), HR rest (76.15±3.01 vs. 77.65±4.16; P =0.041), HR max (143.1±5.24 vs. 147.57±8.63; P =0.011), and RPP (9.64±0.81 vs. 10.07±0.99; P =0.007) and significant elevations in (45.75±4.31 vs. 43.5±5.21; P =0.039), distance walked (514.95±214.5 vs. 368.04±221.43; P =0.019), Mets (7.41±0.84 vs. 6.89±1.28; P =0.018), as well as HRQOL in the MCS (50.62±10.45 vs. 46.25±7.74; P =0.037), and HRQOL in the PCS (46.75±8.73 vs. 42.37±9.99; P =0.040) in the intervention group compared to the control group. Conclusion: An HBCT program consisting of supervised exercise training significantly improved hemodynamic response, exercise performance capacity, and HRQOL in patients following PCI.

Discussion

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Cite This Study

Dehghani et al. (2024) conducted an RCT in Coronary artery disease following percutaneous coronary intervention (PCI) (n=80). Home-based cardiac telerehabilitation (HBCT) vs. Routine care / unsupervised exercise recommendation (physician recommendation to walk 30-40 min five times a week without supervised exercise training) plus usual medications was evaluated on Distance walked on modified Bruce treadmill test (m) at 8 weeks (p=0.019). Home-based cardiac telerehabilitation increased treadmill distance walked and LVEF compared to control in post-PCI patients.

synapsesocial.com/papers/6a844de6ac510c864ff30946 https://doi.org/10.1097/ms9.0000000000002235

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Effects of cardiac telerehabilitation during COVID-19 on cardiac hemodynamic and functional responses and quality of life: a randomized controlled trial

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Effects of cardiac telerehabilitation during COVID-19 on cardiac hemodynamic and functional responses and quality of life: a randomized controlled trial

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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