IMPORTANCE Guidelines recommend exercise training as a component of heart failure management. There are large disparities in access to rehabilitation, and introducing hybrid comprehensive telerehabilitation (HCTR) consisting of remote monitoring of training at patients' homes might be an appealing alternative.OBJECTIVE To assess whether potential improvements in quality-of-life outcomes after a 9-week HCTR intervention in patients with heart failure translate into improvement in clinical outcomes during extended 12 to 24 months of follow-up, compared with usual care. DESIGN, SETTING, AND PARTICIPANTSThe Telerehabilitation in Heart Failure Patients (TELEREH-HF) trial is a multicenter, prospective, open-label, parallel-group randomized clinical trial that enrolled 850 patients with heart failure up to 6 months after a cardiovascular hospitalization with New York Heart Association levels I, II, or III and left ventricular ejection fraction of 40% or less. Patients from 5 centers in Poland were randomized 1:1 to HCTR plus usual care or usual care only and followed up for 14 to 26 months after randomization.INTERVENTIONS During the first 9 weeks, patients underwent either an HCTR program (1 week in hospital and 8 weeks at home) or usual care with observation. The HCTR intervention encompassed telecare, telerehabilitation, and remote monitoring of implantable devices. No intervention occurred in the remaining study period. MAIN OUTCOMES AND MEASURESThe percentage of days alive and out of the hospital from randomization through the end of follow-up at 14 to 26 months.RESULTS A total of 850 patients were enrolled, with 425 randomized to the HCTR group (377 male patients [88.7%]; mean [SD] age, 62.6 [10.8] years) and 425 randomized to usual care (376 male patients [88.5%]; mean [SD] age, 62.2 [10.2] years). The HCTR intervention did not extend the percentage of days alive and out of the hospital. The mean (SD) days were 91.9 (19.3) days in the HCTR group vs 92.8 (18.3) days in the usual-care group, with the probability that HCTR extends days alive and out of the hospital equal to 0.49 (95% CI, 0.46-0.53; P = .74) vs usual care. During follow-up, 54 patients died in the HCTR arm and 52 in the usual-care arm, with mortality rates at 26 months of 12.5% vs 12.4%, respectively (hazard ratio, 1.03 [95% CI, 0.70-1.51]). There were also no differences in hospitalization rates (hazard ratio, 0.94 [95% CI, 0.79-1.13]). The HCTR intervention was effective at 9 weeks, significantly improving peak oxygen consumption (0.95 [95% CI, 0.65-1.26] mL/kg/min vs 0.00 [95% CI, −0.31 to 0.30] mL/kg/min; P < .001) and quality of life (Medical Outcome Survey Short Form-36 questionnaire score, 1.58 [95% CI, 0.74-2.42] vs 0.00 [95% CI, −0.84 to 0.84]; P = .008), and it was well tolerated, with no serious adverse events during exercise. CONCLUSIONS AND RELEVANCEIn this trial, the positive effects of a 9-week program of HCTR in patients with heart failure did not lead to the increase in percentage of days alive and out of the hospital and did not red...

Introduction: Hybrid comprehensive telerehabilitation (HCTR) consisting of telecare (with psychological telesupport), telerehabilitation and remote monitoring of implantable devices might be an innovative option improving heart failure (HF) patients' quality of life (QoL) and emotional health. The aim of the study was to investigate the influence of HCTR on various facets of QoL in HF patients in comparison with usual care (UC) alone. Material and methods: The present analysis formed part of a multicenter, randomized trial that enrolled 850 HF patients (NYHA I-III, LVEF ≤ 40%). Patients were randomized 1 : 1 to HCTR plus UC or UC only. Patients underwent either an HCTR program or UC with observation. The psychological intervention in the HCTR group included supportive psychological counseling via mobile phone. The Medical Outcome Survey Short Form 36 Questionnaire was used to assess QoL. Measurements were made before and after a 9-week intervention (HCTR group)/observation (UC group). Results: After the intervention, the HCTR group showed significant improvement in overall QoL, physical domain (PD) of QoL, and 4 areas of QoL (physical functioning (PhF), role functioning related to physical state (RF), general health (GH), vitality (VI)). A significant positive change in QoL in

IntroductionPatients undergoing coronary artery bypass grafting (CABG) are at risk of strokes and neurocognitive disorders.The aim of the studyThe aim of the study was to assess the clinical utility of susceptibility-weighted imaging (SWI) MRI in detection of new brain lesions in patients after CABG. We assessed the incidence and types of brain lesions and correlated the data with neurological examinations in groups of patients who underwent on-pump and off-pump CABG.Material and methodsPatients underwent a neurological examination and MRI before, 6-20 days after and 6 months after the CABG. Fifty-one patients (43 men, mean age 63.12 years) were analyzed.ResultsFifteen (29.4%) patients underwent on-pump CABG, 36 (70.6%) off-pump CABG. On postoperative scans new lesions were detected in 12 (23.5%) patients. Ischemic lesions (visible on diffusion-weighted imaging [DWI]) were detected in 4 patients, in 6 lesions were visible on SWI, in 1 case lesions were visible on SWI and DWI. Hemorrhagic stroke was observed in 1 patient. In the group of patients who underwent on-pump CABG, new brain lesions were observed in 60.0% of patients vs. 8.3% of those who underwent off-pump CABG (p < 0.0001); these changes more frequently were multiple (p < 0.0013) and located infratentorially (p < 0.0218). Lesions visible on SWI were observed only in patients undergoing on-pump CABG (p = 0.00005). In all patients (except for 1 with stroke), lesions visible in MRI were clinically silent.ConclusionsThe use of SWI enables one to detect lesions occurring in the brain after CABG, invisible in other sequences. On-pump CABG is associated with a greater risk of clinically silent brain damage compared to off-pump CABG.

Heart failure (HF) significantly reduces physical capacity and harms the overall functioning. In the end-stage cases of HF, the only options are surgical procedures including left ventricular assist devices (LVAD) implantation and heart transplant. Due to the insufficient number of available organs for transplantation, LVAD are used more and more frequently. Rehabilitation of patients with LVAD is a crucial element of therapy because of long-term immobilization of patients awaiting transplant or heart muscle regeneration. Purpose The aim of the study was to evaluate the impact of early hospital rehabilitation on exercise tolerance, muscles strength and complex coordination in LVAD patients. Methods The total of 20 LVAD patients were recruited to the study (all male, aged 19–66 years). All patients underwent standard cardiac rehabilitation in the postoperative and medical treatment wards. After the end of hospitalization, patients were admitted to the rehabilitation department for 4–5 weeks. During that period they performed endurance training, conditioning exercises with elements of resistance and coordination exercises. All patients were tested before and after the rehabilitation program using ergospirometry (CPX), 6-MWT, upper and lower limbs muscle strength (30 Second Chair Stand) and complex coordination (Up&Go test). Results A significant increase in the values of most of studied parameters was observed after exercise training in comparison to the results before rehabilitation process (VO2 peak) [ml/kg/min]: 11.1±2.2 vs. 12.5±2.7, p&lt;0.001; Watt: 42.6±12.4 vs. 54.1±13.1, p&lt;0.0001; 6- MWT [m]: 300.1±102.2 vs. 404.8±105.9, p&lt;0.0001; 30 Seconds Chair Stand [number of stands] 8.4±3.3 vs. 11.6±4.8, p&lt;0.0001; Up&Go [sec] 9.0±1.7 vs. 7.1±1.5, p&lt;0.0001; left hand grip strength [kg]: 31.5±8.4 vs. 34.8±8.1, ns; right hand grip strength [kg]: 33.6±11,2 vs. 36.0±9.0, ns. No adverse effects were observed during rehabilitation process. Conclusions Hospital-based rehabilitation is safe and effective in LVAD patients. Rehabilitation after LVAD implantation brings significant benefits in terms of exercise capacity and tolerance, muscle strength and complex coordination in this group of patients. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): NATIONAL RESEARCH AND DEVELOPMENT CENTER