Home‐based cardiac rehabilitation using information and communication technology for heart failure patients with frailty

Abstract

Aims Cardiac rehabilitation (CR) is an evidence-based, secondary preventive strategy that improves mortality and morbidity rates in patients with heart failure (HF). However, the implementation and continuation of CR remains unsatisfactory, particularly for outpatients with physical frailty. This study investigated the efficacy and safety of a comprehensive home-based cardiac rehabilitation (HBCR) programme that combines patient education, exercise guidance, and nutritional guidance using information and communication technology (ICT). Methods and resultsThis study was a single-centre, open-label, randomized, controlled trial. Between April 2020 and November 2020, 30 outpatients with chronic HF (New York Heart Association II-III) and physical frailty were enrolled. The control group (n = 15) continued with standard care, while the HBCR group (n = 15) also received comprehensive, individualized CR, including ICT-based exercise and nutrition guidance using ICT via a Fitbit® device for 3 months. The CR team communicated with each patient in HBCR group once a week via the application messaging tool and planned the training frequency and intensity of training individually for the next week according to each patient's symptoms and recorded pulse data during exercise. Dietitians conducted a nutritional assessment and then provided individual nutritional advice using the picture-posting function of the application. The primary outcome was the change in the 6 min walking distance (6MWD). The participants' mean age was 63.7 ± 10.1 years, 53% were male, and 87% had non-ischaemic heart disease. The observed change in the 6MWD was significantly greater in the HBCR group (52.1 ± 43.9 m vs. À4.3 ± 38.8 m; P < 0.001) at a 73% of adherence rate. There was no significant change in adverse events in either group. Conclusions Our comprehensive HBCR programme using ICT for HF patients with physical frailty improved exercise tolerance and improved lower extremity muscle strength in our sample, suggesting management with individualized ICT-based programmes as a safe and effective approach. Considering the increasing number of HF patients with frailty worldwide, our approach provides an efficient method to keep patients engaged in physical activity in their daily life.

Effects of Physiatrist and Physiotherapist-supervised Therapeutic Exercise on Physical Function in Frail Older Patients with Multimorbidity

“…Furthermore, because retrospective studies have not been able to investigate when the patient had frailty or multimorbidity, it is unclear whether improvement in physical function is caused by improvement of heart condition or the duration of the disease. Therapeutic exercise improves exercise tolerance and lower muscle strength in frail patients with chronic heart failure, 35 ) and the duration of the disease affects the degree of improvement. Therefore, it is possible that more detailed grouping by stable duration can be used to examine more effective therapeutic exercises for frail older patients with multimorbidity.…”

A Conceptual Model of Home-Based Cardiac Rehabilitation Exercise Adherence in Patients with Chronic Heart Failure: A Constructivist Grounded Theory Study

“… 14–16 Also, a series of studies shown that home-based cardiac rehabilitation has a significant cost-effectiveness and can improve exercise endurance and quality of life, promote mental health, and reduce readmission rates in patients with chronic heart failure. 17–19 …”

“…[14][15][16] Also, a series of studies shown that home-based cardiac rehabilitation has a significant cost-effectiveness and can improve exercise endurance and quality of life, promote mental health, and reduce readmission rates in patients with chronic heart failure. [17][18][19] However, these benefits rely on long-term adherence to home-based cardiac rehabilitation exercises. Unfortunately, the proportion of patients with chronic heart failure who are chronically adherent to home-based cardiac rehabilitation exercise is still suboptimal.…”

Current situation of telemedicine research for cardiovascular risk in Japan

“… There was no statistically significant difference in all-cause death or rehospitalization of heart failure (HR, 0.95; P = NS). Nagatomi et al, 2022 [ 29 ] Chronic heart failure RCT Standard care group ( n = 15) Home-based CR ( n = 15) 67.7 years 59.8 years 3 months Home-based CR group received online counseling via an app or by phone, based on data taken by a smartphone-linked wearable device, symptoms, BP, BW, etc. Home-based CR group showed significant improvement in the 6-min walking distance compared with standard care group.…”

“…Nagatomi et al evaluated whether home-based cardiac rehabilitation (CR) combined with online medical counseling improved the physical activity in patients with chronic heart failure compared with the standard care [ 29 ]. In that single-center, open-label, randomized, controlled trial that included 30 patients with NYHA II-III heart failure, subjects were assigned to home-based CR group or control group.…”