Cardiac telerehabilitation in a middle-income country: analysis of adherence, effectiveness and cost through a randomized clinical trial

Abstract

BACKGROUND The benefits of cardiac rehabilitation (CR) are already well established; however, such intervention has been underused, mainly in low- and middle-income countries. AIM To compare adherence, effectiveness, and cost of a home CR with the traditional CR (TCR) in a middle-income country (MIC). DESIGN Single-blind randomized control trial. SETTING A university hospital. POPULATION Individuals with coronary disease that were eligible were invited to participate. A randomized sample of 51 individuals was selected, where two participants were not included by not meeting inclusion criteria. METHODS The home-CR group participated in health education activities, carried out two supervised exercise sessions, and was instructed to carry out 58 sessions at home. Weekly telephone calls were made. The TCR group held 24 supervised exercise sessions and were instructed to carry out 36 sessions at home. RESULTS 49 individuals (42 male, 56.37±10.35years) participated in the study, 23 in the home-CR group and 26 in the TCR group. After the intervention, adherence in the home-CR and TCR groups was 94.18% and 79.08%, respectively, with no significant difference (P=0.191). Both protocols were effective for the other variables, with no differences. The cost per patient for the service was lower in the home-CR (US$ 59.31) than in the TCR group (US$ 135.05). CONCLUSIONS CR performed at home in an MIC demonstrated similar adherence and effectiveness compared to the TCR program, but with a lower cost for the service. The results corroborate the possibility of using home CR programs, even in MICs, after exercise risk stratification and under remote supervision. CLINICAL REHABILITATION IMPACT Home-CR can contribute to overcome participants’ barriers with compatible cost. Home-CR is effective in improving functional capacity and risk factors control. Perform risk stratification and remote supervision are essential to offer Home-CR.

The cost-effectiveness of exercise-based cardiac telerehabilitation intervention: a systematic review

“…Two studies from samples were conducted in the USA, 21 , 30 New Zealand, 28 , 29 Australia, 24 , 31 Belgium, 22 , 23 and the Netherlands; 20 , 26 one each was conducted in Brazil 27 and Denmark. 25 Most studies (10/12, 83%) were published in the last ten years, and six (50%) were published in the last five years.…”

“…Four studies only included participants with coronary artery disease (CAD). 20 , 28 - 30 Another two studies included a combination of participants after myocardial infarction (MI) or coronary artery bypass graft (CABG), 21 , 27 and two studies included a combination of CAD and chronic heart failure (CHF). 22 , 23 The remaining studies included participants with CHF, 24 cardiovascular risk stage I-II, 26 MI, or a combination of participants with cardiac disease, 25 such as CAD or MI or CHF or CABG.…”

“…An ICT platform was used for telemonitoring 20 , 22 , 26 , 28 - 31 or a personal exercise diary combined with telesupervision. 27 , 30 Patients used HR monitor, 20 , 21 , 26 , 27 , 29 accelerometer, 22 , 23 , 26 web-application 28 , 29 , 31 to monitor exercise intensity. Telesupervision was provided through text messages, 22 , 23 , 28 , 30 , 31 telephone calls, 20 , 26 , 27 audiovisual calls, 24 , 29 or personal visits.…”

“… 27 , 30 Patients used HR monitor, 20 , 21 , 26 , 27 , 29 accelerometer, 22 , 23 , 26 web-application 28 , 29 , 31 to monitor exercise intensity. Telesupervision was provided through text messages, 22 , 23 , 28 , 30 , 31 telephone calls, 20 , 26 , 27 audiovisual calls, 24 , 29 or personal visits. 21 , 25 In studies, monitoring and teleconsultation are mostly performed by physiotherapists, 20 , 24 , 26 , 27 community care teams, 21 , 28 , 29 , 31 nurses, 25 , 30 or semi-automatic web systems.…”

“…Telesupervision was provided through text messages, 22 , 23 , 28 , 30 , 31 telephone calls, 20 , 26 , 27 audiovisual calls, 24 , 29 or personal visits. 21 , 25 In studies, monitoring and teleconsultation are mostly performed by physiotherapists, 20 , 24 , 26 , 27 community care teams, 21 , 28 , 29 , 31 nurses, 25 , 30 or semi-automatic web systems. 22 , 23 Teleconsultations included monitoring adherence to the exercise intervention through training diaries, feedback, motivation for the next period, and identifying barriers to exercise or adverse events.…”