A novel model of home-based, patient-tailored and mobile application-guided cardiac telerehabilitation in patients with atrial fibrillation: A randomised controlled trial

Abstract

Objective: To assess the effectiveness of tele-monitored cardiac rehabilitation in patients who have undergone ablation for atrial fibrillation. Design: Single-centre, prospective, assessment-blinded, randomised controlled trial. Setting: Domiciliary rehabilitation with support from a tertiary care hospital. Subjects: One hundred patients who underwent ablation for atrial fibrillation were recruited. Interventions: Participants were randomly allocated to a 12-week standard rehabilitation treatment (control group) or a comprehensive, domiciliary, mobile application-guided and tele-monitored cardiac rehabilitation program (intervention group) in a 1:1 fashion. Main outcome measures: The primary endpoint was the improvement in VO2peak. The secondary outcomes included adherence, physical activity, beliefs related to cardiovascular disease and exercise self-efficacy. Results: Ninety-seven patients completed follow-up. The mean VO2peak increased significantly in both the intervention group ( n = 49) (baseline vs 12 weeks: 19.1 ± 4.7 vs 27.3 ± 5.6 ml/(min kg), P < 0.01) and the control group ( n = 48) (baseline vs 12 weeks: 18.7 ± 4.9 vs 22.9 ± 6.3 ml/(min kg), P < 0.01). The results of the between-group analysis of aerobic capacity were significantly in favour of the intervention group. During the 12-week program, patients in the intervention group exhibited better adherence than those in the control group. Moreover, self-reported physical activity improved more in the intervention group than in the control group, as did the beliefs related to cardiovascular disease and exercise self-efficacy (all P < 0.01). Conclusions: Our domiciliary, mobile application-guided and tele-monitored cardiac rehabilitation program could lead to a more significant improvements in physical fitness, adherence and health beliefs than standard cardiac rehabilitation in patients who have undergone ablation for atrial fibrillation.

Measurement of Adherence to mHealth Physical Activity Interventions and Exploration of the Factors That Affect the Adherence: Scoping Review and Proposed Framework

“…The characteristics of the included studies are summarized and reported in Textbox 1 (refer to Multimedia Appendix 3 [ 18 - 71 ] for full details). Most of the interventions were delivered through smartphone apps.…”

“…Randomized controlled trial design (33 studies) [ 18 , 20 - 22 , 24 , 25 , 30 , 31 , 33 , 34 , 39 - 47 , 50 - 53 , 57 , 58 , 60 , 61 , 63 , 65 - 68 , 71 ], including 9 pilot studies with small sample sizes [ 20 , 21 , 33 , 40 , 42 , 47 , 50 , 51 , 68 ]…”

“…Helping users to self-monitor and document their behavior (such as physical activity, diet, and weight; 49 studies) [ 18 - 20 , 22 - 30 , 32 - 35 , 37 - 50 , 53 - 71 ]…”

The Combined Effects of Patient Activation and Relational Aspects on the Quality of Life in Atrial Fibrillation Patients

“…Exercise-based CR has been confirmed excellent results for AF patients, including improving AF symptoms, cardiac function and QoL, decreasing resting heart rate, increasing exercise capacity ( Malmo et al, 2016 ; Risom et al, 2017 ; Smart et al, 2018 ; Kato et al, 2019 ). In our study, 32.6% participated in the home-based, patient-tailored and mobile application-guided cardiac telerehabilitation program ( Cai et al, 2021 ), reporting higher AFEQT score than those who did not. These results were concordant with the findings of previous studies.…”

Exercise Training and Its Far-Reaching Effects

“…These include percutaneous coronary interventions, systolic heart failure, valve procedures, angina, and heart transplant. Recent papers published in excellent journals point to the benefit for those with an implantable cardiac defibrillator (1) and those who have undergone an ablation procedure to treat atrial fibrillation (2). So, we may see these patients in our programs in the future.…”