Effects of hybrid comprehensive telerehabilitation on cardiopulmonary capacity in heart failure patients depending on diabetes mellitus: subanalysis of the TELEREH-HF randomized clinical trial.
| Autor: | Główczyńska R; 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland., Piotrowicz E; Telecardiology Center, National Institute of Cardiology, Alpejska Str. 42, 04-828, Warsaw, Poland. epiotrowicz@ikard.pl., Szalewska D; Clinic of Rehabilitation Medicine, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland., Piotrowicz R; National Institute of Cardiology, Warsaw, Poland.; Warsaw Academy of Medical Rehabilitation, Warsaw, Poland., Kowalik I; National Institute of Cardiology, Warsaw, Poland., Pencina MJ; Duke University School of Medicine, Durham, NC, USA., Zaręba W; University of Rochester Medical Center, Rochester, NY, USA., Banach M; Department of Hypertension, Medical University of Łódź, Lodz, Poland., Orzechowski P; Telecardiology Center, National Institute of Cardiology, Alpejska Str. 42, 04-828, Warsaw, Poland., Pluta S; Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian Medical University, Zabrze, Poland., Irzmański R; Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Łódź, Lodz, Poland., Kalarus Z; Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian Medical University, Zabrze, Poland., Opolski G; 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. |
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| Jazyk: | angličtina |
| Zdroj: | Cardiovascular diabetology [Cardiovasc Diabetol] 2021 May 13; Vol. 20 (1), pp. 106. Date of Electronic Publication: 2021 May 13. |
| DOI: | 10.1186/s12933-021-01292-9 |
| Abstrakt: | Background: Type 2 diabetes mellitus (DM) is one of the most common comorbidities among patients with heart failure (HF) with reduced ejection fraction (HFrEF). There are limited data regarding efficacy of hybrid comprehensive telerehabilitation (HCTR) on cardiopulmonary exercise capacity in patients with HFrEF with versus those without diabetes. Aim: The aim of the present study was to analyze effects of 9-week HCTR in comparison to usual care on parameters of cardiopulmonary exercise capacity in HF patients according to history of DM. Methods: Clinically stable HF patients with left ventricular ejection fraction [LVEF] < 40% after a hospitalization due to worsening HF within past 6 months were enrolled in the TELEREH-HF (The TELEREHabilitation in Heart Failure Patients) trial and randomized to the HCTR or usual care (UC). Cardiopulmonary exercise tests (CPET) were performed on treadmill with an incremental workload according to the ramp protocol. Results: CPET was performed in 385 patients assigned to HCTR group: 129 (33.5%) had DM (HCTR-DM group) and 256 patients (66.5%) did not have DM (HCTR-nonDM group). Among 397 patients assigned to UC group who had CPET: 137 (34.5%) had DM (UC-DM group) and 260 patients (65.5%) did not have DM (UC-nonDM group). Among DM patients, differences in cardiopulmonary parameters from baseline to 9 weeks remained similar among HCTR and UC patients. In contrast, among patients without DM, HCTR was associated with greater 9-week changes than UC in exercise time, which resulted in a statistically significant interaction between patients with and without DM: difference in changes in exercise time between HCTR versus UC was 12.0 s [95% CI - 15.1, 39.1 s] in DM and 43.1 s [95% CI 24.0, 63.0 s] in non-DM, interaction p-value = 0.016. Furthermore, statistically significant differences in the effect of HCTR versus UC between DM and non-DM were observed in ventilation at rest: - 0.34 l/min [95% CI - 1.60, 0.91 l/min] in DM and 0.83 l/min [95% CI - 0.06, 1.73 l/min] in non-DM, interaction p value = 0.0496 and in VE/VCO Conclusions: The benefits of hybrid comprehensive telerehabilitation versus usual care on the improvement of physical performance, ventilatory profile and gas exchange parameters were more pronounced in patients with HFrEF without DM as compared to patients with DM. Trial Registration: ClinicalTrials.gov Identifier: NCT02523560. Registered 3rd August 2015. https://clinicaltrials.gov/ct2/show/NCT02523560?term=NCT02523560&draw=2&rank=1 . Other Study ID Numbers: STRATEGME1/233547/13/NCBR/2015. |
| Databáze: | MEDLINE |
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