Effectiveness of Home-Based Mobile Guided Cardiac Rehabilitation as Alternative Strategy for Nonparticipation in Clinic-Based Cardiac Rehabilitation Among Elderly Patients in Europe

Autor:	Snoek, Johan A., Prescott, Eva I., Van Der Velde, Astrid E., Eijsvogels, Thijs M. H., Mikkelsen, Nicolai, Prins, Leonie F., Bruins, Wendy, Meindersma, Esther, González-Juanatey, José R., Peña-Gil, Carlos, González-Salvado, Violeta, Moatemri, Feriel, Iliou, Marie-Christine, Marcin, Thimo, Eser, Prisca, Wilhelm, Matthias, Van’t Hof, Arnoud W.J., De Kluiver, Ed P.
Jazyk:	angličtina
Rok vydání:	2020
Předmět:	Aged 80 and over Male Cardiac Rehabilitation Research Brief Report Monitoring Ambulatory 610 Medicine & health Motivational Interviewing Home Care Services Mobile Applications Europe Physical Fitness cardiovascular system Online First Humans Female Smartphone Aged
Zdroj:	JAMA Cardiology Snoek, Johan A.; Prescott, Eva I.; van der Velde, Astrid E.; Eijsvogels, Thijs M. H.; Mikkelsen, Nicolai; Prins, Leonie F.; Bruins, Wendy; Meindersma, Esther; González-Juanatey, José R.; Peña-Gil, Carlos; González-Salvado, Violeta; Moatemri, Feriel; Iliou, Marie-Christine; Marcin, Thimo; Eser, Prisca; Wilhelm, Matthias; Van’t Hof, Arnoud W.J.; de Kluiver, Ed P. (2021). Effectiveness of Home-Based Mobile Guided Cardiac Rehabilitation as Alternative Strategy for Nonparticipation in Clinic-Based Cardiac Rehabilitation Among Elderly Patients in Europe. JAMA cardiology, 6(4), pp. 463-468. American Medical Association 10.1001/jamacardio.2020.5218
ISSN:	2380-6591 2380-6583
DOI:	10.1001/jamacardio.2020.5218
Popis:	This randomized clinical study assesses whether a 6-month mobile cardiac rehabilitation program is an effective therapy for elderly patients who decline participation in cardiac rehabilitation. Key Points Question Is home-based cardiac rehabilitation an effective therapy for elderly patients who decline conventional cardiac rehabilitation? Findings In this international, multicenter, randomized clinical trial including 179 patients, 6 months of home-based mobile cardiac rehabilitation was associated with a greater increase in physical fitness compared with no cardiac rehabilitation. These beneficial adaptations were sustainable at 1-year follow-up, whereas the incidence of adverse events was low and similar between the intervention and control groups. Meaning These findings suggest that home-based mobile cardiac rehabilitation for elderly patients is safe and effective in changing physical fitness for patients that are not able or willing to participate in conventional cardiac rehabilitation. Importance Although nonparticipation in cardiac rehabilitation is known to increase cardiovascular mortality and hospital readmissions, more than half of patients with coronary artery disease in Europe are not participating in cardiac rehabilitation. Objective To assess whether a 6-month guided mobile cardiac rehabilitation (MCR) program is an effective therapy for elderly patients who decline participation in cardiac rehabilitation. Design, Setting, and Participants Patients were enrolled in this parallel multicenter randomized clinical trial from November 11, 2015, to January 3, 2018, and follow-up was completed on January 17, 2019, in a secondary care system with 6 cardiac institutions across 5 European countries. Researchers assessing primary outcome were masked for group assignment. A total of 4236 patients were identified with a recent diagnosis of acute coronary syndrome, coronary revascularization, or surgical or percutaneous treatment for valvular disease, or documented coronary artery disease, of whom 996 declined to start cardiac rehabilitation. Subsequently, 179 patients who met the inclusion and exclusion criteria consented to participate in the European Study on Effectiveness and Sustainability of Current Cardiac Rehabilitation Programmes in the Elderly trial. Data were analyzed from January 21 to October 11, 2019. Interventions Six months of home-based cardiac rehabilitation with telemonitoring and coaching based on motivational interviewing was used to stimulate patients to reach exercise goals. Control patients did not receive any form of cardiac rehabilitation throughout the study period. Main Outcomes and Measures The primary outcome parameter was peak oxygen uptake (Vo2peak) after 6 months. Results Among 179 patients randomized (145 male [81%]; median age, 72 [range, 65-87] years), 159 (89%) were eligible for primary end point analysis. Follow-up at 1 year was completed for 151 patients (84%). Peak oxygen uptake improved in the MCR group (n = 89) at 6 and 12 months (1.6 [95% CI, 0.9-2.4] mL/kg−1/min−1 and 1.2 [95% CI, 0.4-2.0] mL/kg−1/min−1, respectively), whereas there was no improvement in the control group (n = 90) (+0.2 [95% CI, −0.4 to 0.8] mL/kg−1/min−1 and +0.1 [95% CI, −0.5 to 0.7] mL/kg−1/min−1, respectively). Changes in Vo2peak were greater in the MCR vs control groups at 6 months (+1.2 [95% CI, 0.2 to 2.1] mL/kg−1/min−1) and 12 months (+0.9 [95% CI, 0.05 to 1.8] mL/kg−1/min−1). The incidence of adverse events was low and did not differ between the MCR and control groups. Conclusions and Relevance These results suggest that a 6-month home-based MCR program for patients 65 years or older with coronary artery disease or a valvular intervention was safe and beneficial in improving Vo2peak when compared with no cardiac rehabilitation. Trial Registration trialregister.nl Identifier: NL5168
Databáze:	OpenAIRE
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