2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

Abstract

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/ Heart Rhythm Society/ European Heart Rhythm Association/ Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self‐management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

Antiarrhythmic effect of 9-week hybrid comprehensive telerehabilitation and its influence on cardiovascular mortality in long-term follow-up – subanalysis of the TELEREHabilitation in Heart Failure Patients randomized clinical trial

“…Changes in the electrical and mechanical function of the failure heart including left ventricular remodeling, fibrosis, regional hypertrophy and increased vascular resistances, can predispose a HF patient to VA. 1,12 One of the factors responsible for VA in HF patients is the activation of neurohormonal mechanisms.…”

“…Sympathetic stimulation and down-regulation of the parasympathetic system contribute not only to the proarrhythmic environment, but also to changes in the mechanical function of the heart muscle that lead to myocardial remodeling and fibrosis, which in turn increases the risk of arrhythmias. 1 Considering the above, it should be noted that physical effort during exercise training can lead to an acute increase in the susceptibility to VA by activating the sympathetic nervous system, decreasing vagal activity and increasing hemodynamic overload of the cardiovascular system. 13,14 These considerations underscore the importance of exercise training plan in terms of its type (endurance, resistance and strength), intensity (aerobic versus anaerobic); method (continuous versus intermittent/interval); setting (centre-based versus home-based); application (systemic, regional and respiratory muscle) and control (supervised versus non-supervised).…”

“…Hybrid cardiac telerehabilitation is a novel component of heart failure (HF) management but its effect on ventricular arrhythmias (VA) is not well recognized. 1 Ventricular arrhythmia is a common problem in patients with HF regardless of etiology.…”

Heart Failure Patients’ Adherence to Hybrid Comprehensive Telerehabilitation and Its Impact on Prognosis Based on Data from TELEREH-HF Randomized Clinical Trial

“…Despite the progress in pharmacological and non-pharmacological treatment of HF, the effects achieved are not always optimal. An important factor determining results after the treatment or the introduction of a new therapeutic procedure is patients' adherence, which can affect their prognosis [10][11][12]. Therefore, both in the assessment of pharmacological treatment as well as in the evaluation of new procedures, it is advisable to evaluate them also in terms of their adherence.…”

“…The development of new telemedicine technologies made it possible to introduce a program of telerehabilitation that might be an option to overcome barriers hindering the implementation of cardiac rehabilitation in everyday clinical practice [1,6,7,[9][10][11][12]15].…”