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Home-based mobile guided cardiac rehab may be safe and beneficial

JAMA Cardiology
Reuters Health - 29/10/2020 - A six-month home-based mobile guided cardiac rehab program may offer a safe and moderately effective alternative for elderly patients who do not wish to participate in a conventional program, a new study suggests.

In an analysis of data from nearly 200 older patients who were randomly assigned to either a control group that received no cardiac rehab or one that received mobile guided cardiac rehab (MCR), researchers found improvements in peak oxygen uptake in those who received MCR, according to the report published in JAMA Cardiology.

"In this RCT, a home-based MCR program of six months for elderly patients who decline participation in conventional cardiac rehabilitation was superior in changing physical fitness at 6- and 12-month follow-up when compared with usual care with no cardiac rehabilitation," the researchers, led by Dr. Johan Snoek of the Isala Heart Center in Zwolle, the Netherlands, write. "Furthermore, MCR could be a safe alternative to improve fitness and increase physical activity in older patients. Future studies are warranted to explore the long-term clinical benefits of MCR in this patient group, including longevity, attenuated disease progression and a reduced risk for adverse cardiovascular events."

The authors did not respond to a request for comments.

To examine the impact of a home rehab program, the researchers recruited patients who were 65 or older with a recent diagnosis of acute coronary syndrome, coronary revascularization, surgical or percutaneous treatment for valvular disease or documented coronary artery disease defined by standard noninvasive or invasive methods, and who declined participation in center-based cardiac rehabilitation.

The 179 patients (median age 72) chosen to participate in the study were randomly assigned to either the control group or to an intervention group that was offered a six-month home based cardiac rehabilitation program in which they were equipped with a smartphone and a heart rate belt. The MCR patients were instructed to exercise at moderate intensity for at least 30 minutes a day, five days a week.

The patients received motivational phone calls weekly in the first month, every other week in the second month, and monthly after that until the study ended.

Follow-up at one year was completed for 151 patients (84%). Peak oxygen uptake improved in the MCR group (n = 89), with a relative increase of 8.5% at six months (1.6 mL/kg-1/min-1 ) and 6.3% at 12 months (1.2 mL/kg-1/min-1), whereas there was no improvement in the control group (n = 90).

Changes in VO2 peak were greater in the MCR versus control groups at six months (+1.2 mL/kg-1/min-1) and 12 months (+0.9 mL/kg-1/min-1). The incidence of adverse events was low and did not differ between the MCR and control groups.

Diastolic blood pressure remained stable at six months in the MCR group and increased in the control group. In addition, HbA1c level increased in the control group at 12months whereas it remained stable in the MCR group.

Experts welcomed the new study.

"The benefits of cardiac rehabilitation are well-established, including improved functional capacity, fewer recurrent cardiovascular events, and reduced cardiovascular mortality, but few eligible patients participate, particularly patients who are older," said Dr. Daniel Forman, a professor of medicine at the University of Pittsburgh and chair of the section of geriatric cardiology at UPMC. "For many, the logistics of getting to a site-based cardiac rehabilitation program becomes a key impediment."

The new study is "important," Dr. Forman said. "The results showed significantly greater improvements in peak oxygen uptake, a measure of cardiorespiratory fitness, in those who were in the remote cardiac rehabilitation versus usual care at both 6 months and one year. Furthermore, a patient-reported measure of habitual physical activity was greater in the remote cardiac rehabilitation group versus usual care. Improvements in blood pressure and blood glucose were also greater in the remote cardiac rehabilitation group versus usual care."

What it doesn't tell us, Dr. Forman said, is how these results compare to traditional in-center rehab.

The new study is timely, said Dr. Joshua Shatzkes, an assistant professor of medicine and cardiology at the Icahn School of Medicine at Mount Sinai and a cardiologist at Mount Sinai Hospital in New York City.

"In the time of the pandemic where people are less likely to go to a center for rehab the idea that it can be done without going there, this is welcome," Dr. Shatzkes said. "Even without the pandemic, there are many barriers to patients getting cardiac rehabilitation."

Dr. Shatzkes also applauded the researchers for reporting peak oxygen uptake rather than relying on patients' self-reports.

By Linda Carroll

SOURCE: https://bit.ly/3kJsCM7 JAMA Cardiology, online October 28, 2020.

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