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Li R, Wang M, Chen S, Zhang L. Comparative efficacy and adherence of telehealth cardiac rehabilitation interventions for patients with cardiovascular disease: A systematic review and network meta-analysis. Int J Nurs Stud 2024; 158:104845. [PMID: 39032245 DOI: 10.1016/j.ijnurstu.2024.104845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Traditional center-based cardiac rehabilitation had low adherence rates. With the increasing utilization of digital technology in healthcare services, telehealth can overcome common barriers to improve adherence, and some telehealth interventions have been proven safe and effective. However, it remains unclear which telehealth intervention types can maximize the efficacy and adherence for cardiac rehabilitation. OBJECTIVE To compare the effect of different types of telehealth interventions on the efficacy and adherence of patients with cardiovascular disease in cardiac rehabilitation. DESIGN Systematic review and network meta-analysis. METHODS We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, ProQuest, Scopus, and Embase databases for randomized controlled trials of telehealth cardiac rehabilitation for cardiovascular disease patients from January 2013 to March 2024. The primary outcomes were peak oxygen uptake (VO2 peak) and adherence. Secondary outcomes included 6-minute walking distance, moderate-to-vigorous intensity physical activity, depression, self-reported quality of life, and patient satisfaction. The study protocol has been registered on PROSPERO (ID: CRD42023459643). RESULTS This network meta-analysis included 46 randomized controlled trials. The results indicated that telehealth cardiac rehabilitation improved VO2 peak, 6-minute walking distance, moderate-to-vigorous intensity physical activity, and adherence. The surface under the cumulative ranking curve (SUCRA) results showed that the Wearable Devices + Smartphone Applications (SUCRA = 86.8 %, mean rank = 1.7) was the most effective telehealth intervention for improving VO2 peak. The Smartphone Applications + Instant Communication Tools (SUCRA = 74.2 %, mean rank = 2.6) was the most effective telehealth intervention for promoting adherence. CONCLUSIONS Combining two or more types of telehealth interventions was found to be effective. Future efforts should prioritize conducting high-quality randomized controlled trials to identify more effective combinations with traditional cardiac rehabilitation.
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Affiliation(s)
- Ruru Li
- The First School of Medicine, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Miao Wang
- The School of Nursing, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Shuoshuo Chen
- The First School of Medicine, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Liqing Zhang
- The Department of Nursing, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China.
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McGrath A, McHale S, Hanson CL, McLelland C, Hamilton DF. Completeness of intervention reporting in randomised trials of technology-enabled remote or hybrid exercise-based cardiac rehabilitation: a systematic review using the TIDieR framework. Disabil Rehabil 2024; 46:4350-4358. [PMID: 37899659 DOI: 10.1080/09638288.2023.2274887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Exercise-based cardiac rehabilitation improves clinical outcomes and quality of life. Technology-enabled delivery of remote cardiac rehabilitation is as effective in improving health outcomes as in-person delivery and has the potential to transform clinical service delivery. However, for the successful translation of research to clinical practice, interventions must be adequately reported in the literature. METHODS Systematic review of MedLine, CINAHL, PubMed and SPORT Discus databases applying PRISMA guidance. Randomised controlled trials of remote or hybrid technology-enabled exercise-based cardiac rehabilitation interventions were included. Completeness of reporting was evaluated against the TIDieR checklist. RESULTS The search strategy returned 162 articles which, following screening, resulted in 12 randomised trials being included containing data for 1588 participants. No trial fully reported their rehabilitation intervention as per the 12-item TIDieR checklist, with a median score of eight out of 12 categories. Notably, intervention detail, dosage and modification were comparatively poorly reported. CONCLUSION Technology-enabled remotely delivered cardiac rehabilitation may be effective at improving cardiovascular fitness; however, the quality of reporting of these interventions in randomised trials is insufficient for replication which has material implications for translation into clinical practice.
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Affiliation(s)
- Aoife McGrath
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Sheona McHale
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Colin McLelland
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- MAHD National Sports Academy, Riyadh, Saudi Arabia
| | - David F Hamilton
- Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
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Cruz-Cobo C, Bernal-Jiménez MÁ, Calle G, Gheorghe LL, Gutiérrez-Barrios A, Cañadas D, Tur JA, Vázquez-García R, Santi-Cano MJ. Efficacy of a Mobile Health App (eMOTIVA) Regarding Compliance With Cardiac Rehabilitation Guidelines in Patients With Coronary Artery Disease: Randomized Controlled Clinical Trial. JMIR Mhealth Uhealth 2024; 12:e55421. [PMID: 39052330 PMCID: PMC11310647 DOI: 10.2196/55421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/17/2024] [Accepted: 05/28/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Cardiac rehabilitation is fundamental among patients recovering from a coronary event, and mHealth technology may constitute a useful tool that provides guidelines based on scientific evidence in an entertaining, attractive, and user-friendly format. OBJECTIVE This study aimed to compare the efficacy of an mHealth intervention involving the eMOTIVA app and that of usual care regarding compliance with cardiac rehabilitation guidelines in terms of lifestyle, cardiovascular risk factors, and satisfaction among patients with acute coronary syndrome. METHODS A randomized controlled clinical trial with a parallel group design was conducted. It included 300 patients (mHealth group, 150; control group, 150) who underwent percutaneous coronary intervention for acute coronary syndrome. Both groups underwent evaluations initially (during hospitalization) and after 3 and 6 months (face-to-face consultations). The eMOTIVA app incorporates a virtual classroom providing audio and video information about a healthy lifestyle, a section for self-recording cardiovascular risk factors, and a section for feedback messages and gamification. The primary outcome variables were (1) adherence to the Mediterranean diet and the frequency of consumption of food; (2) physical activity level, sedentary time, and exercise capacity; (3) smoking cessation and nicotine dependence; (4) level of knowledge about cardiovascular risk factors; and (5) app satisfaction and usability. RESULTS The study analyzed 287 patients (mHealth group, 145; control group, 142). Most participants were male (207/300, 69.0%), and the mean age was 62.53 (SD 8.65) years. Significant improvements were observed in the mHealth group compared with the control group at 6 months in terms of (1) adherence to the Mediterranean diet (mean 11.92, SD 1.70 vs 8.92, SD 2.66 points; P<.001) and frequency of eating foods (red meat [≤1/week]: 141/143, 97.9% vs 96/141, 68.1%; industrial pastries [<2/week]: 129/143, 89.6% vs 80/141, 56.8%; oily fish [≥2/week]: 124/143, 86.1% vs 64/141, 41.4%; vegetables [≥2/day]: 130/143, 90.3% vs 78/141, 55.3%; fruit [≥2/day]: 128/143, 88.9% vs 85/141, 60.2%; all P<.001); (2) physical activity (mean 2112.66, SD 1196.67 vs 1372.60, SD 944.62 metabolic equivalents/week; P<.001) and sedentary time (mean 8.38, SD 1.88 vs 9.59, SD 2.09 hours; P<.001); (3) exercise capacity (distance: mean 473.49, SD 102.28 vs 447.25, SD 93.68 meters; P=.04); and (4) level of knowledge (mean 117.85, SD 3.83 vs 111.00, SD 7.11 points; P<.001). App satisfaction was high (mean 42.53, SD 6.38 points), and its usability was excellent (mean 95.60, SD 4.03 points). CONCLUSIONS With the eMOTIVA app, favorable results were obtained in the intervention group in terms of adherence to the Mediterranean diet, frequency of eating certain foods, physical activity, sedentary time, exercise capacity, knowledge level, systolic blood pressure, heart rate, and blood sugar level. Furthermore, participants reported high app satisfaction and rated its usability as excellent. Thus, this innovative tool is very promising. TRIAL REGISTRATION ClinicalTrials.gov NCT05247606; https://clinicaltrials.gov/study/NCT05247606.
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Affiliation(s)
- Celia Cruz-Cobo
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - María Ángeles Bernal-Jiménez
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
| | - Germán Calle
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Clinical Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Livia Luciana Gheorghe
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Clinical Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Alejandro Gutiérrez-Barrios
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Clinical Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Dolores Cañadas
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Clinical Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - Josep A Tur
- Research Group on Community Nutrition & Oxidative Stress, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Rafael Vázquez-García
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Cardiology Clinical Unit, Puerta del Mar Hospital, Cádiz, Spain
| | - María José Santi-Cano
- Faculty of Nursing and Physiotherapy, University of Cádiz, Cádiz, Spain
- Institute of Biomedical Research and Innovation of Cádiz, Cádiz, Spain
- Research Group on Nutrition, Molecular, Pathophysiological and Social Issues, University of Cádiz, Cádiz, Spain
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Fucarino A, Fabbrizio A, Garrido ND, Iuliano E, Reis VM, Sausa M, Vilaça-Alves J, Zimatore G, Baldari C, Macaluso F, Giorgio AD, Cantoia M. Emerging Technologies and Open-Source Platforms for Remote Physical Exercise: Innovations and Opportunities for Healthy Population-A Narrative Review. Healthcare (Basel) 2024; 12:1466. [PMID: 39120170 PMCID: PMC11312124 DOI: 10.3390/healthcare12151466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/15/2024] [Accepted: 07/21/2024] [Indexed: 08/10/2024] Open
Abstract
The emergence of tele-exercise as a response to the impact of technology on physical activity has opened up new possibilities for promoting physical health. By integrating innovative technologies and open-source platforms, tele-exercise encourages people to stay active. In our latest analysis, we delved into the scientific literature surrounding the use of tele-exercise technologies in training healthy individuals. After conducting an extensive search on the PubMed database using the keywords "tele-exercise" and "physical activity" (from 2020 to 2023), we identified 44 clinical trials that were applicable to tele-exercise, but less than 10% of them were aimed at healthy individuals, precisely 9.09% (four out of forty-four studies analyzed). Our review highlights the potential of tele-exercise to help maintain physical fitness and psychological well-being, especially when traditional fitness facilities are not an option. We also underscore the importance of interoperability, standardization, and the incorporation of biomechanics, exercise physiology, and neuroscience into the development of tele-exercise platforms. Nevertheless, despite these promising benefits, research has shown that there is still a significant gap in the knowledge concerning the definition and evaluation of training parameters for healthy individuals. As a result, we call for further research to establish evidence-based practices for tele-exercise in the healthy population.
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Affiliation(s)
- Alberto Fucarino
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy; (A.F.); (A.F.); (E.I.); (M.S.); (G.Z.); (C.B.); (A.D.G.); (M.C.)
| | - Antonio Fabbrizio
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy; (A.F.); (A.F.); (E.I.); (M.S.); (G.Z.); (C.B.); (A.D.G.); (M.C.)
| | - Nuno D. Garrido
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 5000-801 Vila Real, Portugal; (N.D.G.); (V.M.R.); (J.V.-A.)
| | - Enzo Iuliano
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy; (A.F.); (A.F.); (E.I.); (M.S.); (G.Z.); (C.B.); (A.D.G.); (M.C.)
| | - Victor Machado Reis
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 5000-801 Vila Real, Portugal; (N.D.G.); (V.M.R.); (J.V.-A.)
| | - Martina Sausa
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy; (A.F.); (A.F.); (E.I.); (M.S.); (G.Z.); (C.B.); (A.D.G.); (M.C.)
| | - José Vilaça-Alves
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 5000-801 Vila Real, Portugal; (N.D.G.); (V.M.R.); (J.V.-A.)
- Sciences Departament, University of Tra’s-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
| | - Giovanna Zimatore
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy; (A.F.); (A.F.); (E.I.); (M.S.); (G.Z.); (C.B.); (A.D.G.); (M.C.)
| | - Carlo Baldari
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy; (A.F.); (A.F.); (E.I.); (M.S.); (G.Z.); (C.B.); (A.D.G.); (M.C.)
| | - Filippo Macaluso
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy; (A.F.); (A.F.); (E.I.); (M.S.); (G.Z.); (C.B.); (A.D.G.); (M.C.)
| | - Andrea De Giorgio
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy; (A.F.); (A.F.); (E.I.); (M.S.); (G.Z.); (C.B.); (A.D.G.); (M.C.)
| | - Manuela Cantoia
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy; (A.F.); (A.F.); (E.I.); (M.S.); (G.Z.); (C.B.); (A.D.G.); (M.C.)
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Hou QL, Liu LY, Wu Y. The Effects of mHealth Interventions on Quality of Life, Anxiety, and Depression in Patients With Coronary Heart Disease: Meta-Analysis of Randomized Controlled Trials. J Med Internet Res 2024; 26:e52341. [PMID: 38861710 PMCID: PMC11200038 DOI: 10.2196/52341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/05/2024] [Accepted: 03/22/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is the leading cause of death globally. In addition, 20% to 40% of the patients with CHD have comorbid mental health issues such as anxiety or depression, affecting the prognosis and quality of life (QoL). Mobile health (mHealth) interventions have been developed and are widely used; however, the evidence for the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD is currently ambiguous. OBJECTIVE In this study, we aimed to assess the effects of mHealth interventions on QoL, anxiety, and depression in patients with CHD. METHODS We searched the Cochrane Library, PubMed, Embase, CINAHL, Web of Science, China National Knowledge Infrastructure, and Wanfang databases from inception to August 12, 2023. Eligible studies were randomized controlled trials that involved patients with CHD who received mHealth interventions and that reported on QoL, anxiety, or depression outcomes. We used the Cochrane risk-of-bias tool for randomized trials to evaluate the risk of bias in the studies, ensuring a rigorous and methodologically sound analysis. Review Manager (desktop version 5.4; The Cochrane Collaboration) and Stata MP (version 17.0; StataCorp LLC) were used to conduct the meta-analysis. The effect size was calculated using the standardized mean difference (SMD) and its 95% CI. RESULTS The meta-analysis included 23 studies (5406 participants in total) and showed that mHealth interventions significantly improved QoL in patients with CHD (SMD 0.49, 95% CI 0.25-0.72; Z=4.07; P<.001) as well as relieved their anxiety (SMD -0.46, 95% CI -0.83 to -0.08; Z=2.38; P=.02) and depression (SMD -0.34, 95% CI -0.56 to -0.12; Z=3.00; P=.003) compared to usual care. The subgroup analyses indicated a significant effect favoring the mHealth intervention on reducing anxiety and depressive symptoms compared to usual care, especially when (1) the intervention duration was ≥6 months (P=.04 and P=.001), (2) the mHealth intervention was a simple one (only 1 mHealth intervention was used) (P=.01 and P<.001), (3) it was implemented during the COVID-19 pandemic (P=.04 and P=.01), (4) it was implemented in low- or middle-income countries (P=.01 and P=.02), (5) the intervention focused on mental health (P=.01 and P=.007), and (6) adherence rates were high (≥90%; P=.03 and P=.002). In addition, comparing mHealth interventions to usual care, there was an improvement in QoL when (1) the mHealth intervention was a simple one (P<.001), (2) it was implemented in low- or middle-income countries (P<.001), and (3) the intervention focused on mental health (P<.001). CONCLUSIONS On the basis of the existing evidence, mHealth interventions might be effective in improving QoL and reducing anxiety and depression in patients with CHD. However, large sample, high-quality, and rigorously designed randomized controlled trials are needed to provide further evidence. TRIAL REGISTRATION PROSPERO CRD42022383858; https://tinyurl.com/3ea2npxf.
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Affiliation(s)
- Qiao Ling Hou
- School of Nursing, Capital Medical University, Beijing, China
| | - Le Yang Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
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Trivedi R, Elshafie S, Tackett R, Young H, Sattler ELP. Effectiveness and Feasibility of Telehealth-Based Dietary Interventions Targeting Cardiovascular Disease Risk Factors: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e49178. [PMID: 38363635 PMCID: PMC10907949 DOI: 10.2196/49178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/17/2023] [Accepted: 11/24/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Telehealth-based dietary interventions were recommended for cardiovascular disease (CVD) management during the COVID-19 pandemic; however, data regarding their effectiveness and feasibility are limited. OBJECTIVE We aimed to examine (1) the effectiveness of telehealth-based dietary interventions in improving clinical CVD risk factors and (2) the feasibility of these interventions among individuals with CVD. METHODS To conduct this systematic review and meta-analysis of randomized controlled trials (RCTs), 2 investigators searched PubMed, Cochrane Library, Web of Science, and ClinicalTrials.gov databases based on predetermined search terms and included English-language RCTs published between January 2000 and July 2022. The Cochrane Risk of Bias tool was used to assess RCT quality. To evaluate intervention effectiveness, weight, BMI, systolic and diastolic blood pressure, and levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, or blood glucose were compared postintervention in telehealth and usual care (UC) groups. Feasibility was determined through the number of participants retained in intervention and UC groups. Pooled data for each CVD outcome were analyzed using a random effects model. Mean difference (MD), standardized MD, or risk ratio were calculated using R software. RESULTS A total of 13 RCTs with 3013 participants were included in the analysis to assess the effectiveness and feasibility of telehealth-based dietary interventions among individuals with CVD. Participants had a mean age of 61.0 (SD 3.7) years, and 18.5% (n=559) were women. Approximately one-third of RCTs were conducted in the United States (n=4, 31%). Included studies used telephone, app, text, audio-visual media, or website-based interventions. Of the 13 included studies, 3 were of high quality, 9 were of moderate quality, and only 1 was of low quality. Pooled estimates showed systolic blood pressure (MD -2.74, 95% CI -4.93 to -0.56) and low-density lipoprotein cholesterol (standardized MD -0.11, 95% CI -0.19 to -0.03) to be significantly improved among individuals with CVD as a result of telehealth-based dietary interventions compared to UC. No significant difference in effectiveness was detected for weight, BMI, and levels of diastolic blood pressure, total cholesterol, high-density lipoprotein, and triglycerides between telehealth-based dietary interventions and UC among those with CVD. There was no significant difference between the feasibility of telehealth-based dietary interventions versus UC. Significant I2 indicated moderate to considerable heterogeneity. CONCLUSIONS Telehealth-based dietary interventions show promise in addressing CVD risk factors.
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Affiliation(s)
- Rupal Trivedi
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, United States
| | - Shaimaa Elshafie
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, United States
| | - Randall Tackett
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, United States
| | - Henry Young
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, United States
| | - Elisabeth Lilian Pia Sattler
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, GA, United States
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, United States
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Hu Y, Ding K, Wu G, Li X, Li J, Shang Z. The Effect of Technology-Based Home Cardiac Rehabilitation on Risk Factor Modifications in Coronary Heart Disease Patients. A Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2024; 25:59. [PMID: 39077346 PMCID: PMC11263160 DOI: 10.31083/j.rcm2502059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/20/2023] [Accepted: 10/08/2023] [Indexed: 07/31/2024] Open
Abstract
Background The delivery channels and approaches related to cardiac rehabilitation (CR), such as eHealth, mHealth, and telehealth, are evolving. Several studies have identified their effects on patients with coronary heart disease, although no studies have focused on all the approaches collectively. Methods Randomized controlled trials have investigated lipid profiles, through systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI). Stata software was used for analysis, while Egger's linear regression test and Begg's funnel plot were also applied. Results Technology-based home CR revealed significantly lower total cholesterol (TC) levels (standardized mean difference (SMD) = -0.19; 95% confidence interval [CI]: [-0.27, -0.11]); triglyceride (TG) levels (SMD = -0.26; 95% CI: [-0.35, 0.17]); low-density lipoprotein (LDL) levels (SMD = -0.18; 95% CI: [ -0.25, -0.11]); SBP (SMD = -0.26; 95% CI: [-0.33, -0.19]); DBP (SMD = -0.24; 95% CI: [-0.32, -0.16]); BMI (SMD = -0.12; 95% CI: [-0.18, -0.05]), and improved high-density lipoprotein (HDL) levels (SMD = 0.22; 95% CI: [0.14, 0.31]). Conclusions Technology-based home CR can be used to lower TC, TG, and LDL levels, alongside the BMI, SBP, and DBP indexes, while also raising HDL levels; thus, its use should be widely promoted.
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Affiliation(s)
- Yemei Hu
- Department of Cardiology, Bengbu Second People’s Hospital, 233000 Bengbu, Anhui, China
| | - Kun Ding
- Department of Cardiology, Bengbu Second People’s Hospital, 233000 Bengbu, Anhui, China
| | - Gang Wu
- Department of Cardiology, Bengbu Second People’s Hospital, 233000 Bengbu, Anhui, China
| | - Xuedong Li
- Department of Cardiology, Bengbu Second People’s Hospital, 233000 Bengbu, Anhui, China
| | - Jun Li
- Department of Cardiology, Bengbu Second People’s Hospital, 233000 Bengbu, Anhui, China
| | - Zhuo Shang
- Department of Cardiology, Bengbu Second People’s Hospital, 233000 Bengbu, Anhui, China
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Dalli-Peydró E, Prades Martí M, Tuzón-Segarra MT, Fresneda-Fresneda A, Muñoz-Ramos N, Cosín-Sales J. Cost-utility of cardiac telerehabilitation versus conventional hospital rehabilitation after ACS in Spain. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:99-101. [PMID: 38165030 DOI: 10.1016/j.rec.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/03/2023] [Indexed: 01/03/2024]
Affiliation(s)
| | - Miriam Prades Martí
- Departamento de Economía de la Salud, Outcomes'10 S.L., Castellón de la Plana, Spain
| | | | | | - Nuria Muñoz-Ramos
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain
| | - Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain
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McDonagh ST, Dalal H, Moore S, Clark CE, Dean SG, Jolly K, Cowie A, Afzal J, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2023; 10:CD007130. [PMID: 37888805 PMCID: PMC10604509 DOI: 10.1002/14651858.cd007130.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017. OBJECTIVES To compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. MAIN RESULTS We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar. AUTHORS' CONCLUSIONS This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.
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Affiliation(s)
- Sinead Tj McDonagh
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Hasnain Dalal
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah Moore
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Christopher E Clark
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah G Dean
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aynsley Cowie
- Cardiac Rehabilitation, University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, UK
| | | | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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10
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Tenforde AS, Alexander JJ, Alexander M, Annaswamy TM, Carr CJ, Chang P, Díaz M, Iaccarino MA, Lewis SB, Millett C, Pandit S, Ramirez CP, Rinaldi R, Roop M, Slocum CS, Tekmyster G, Venesy D, Verduzco-Gutierrez M, Zorowitz RD, Rowland TR. Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research. PM R 2023; 15:1156-1174. [PMID: 37354209 DOI: 10.1002/pmrj.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
Telehealth refers to the use of telecommunication devices and other forms of technology to provide services outside of the traditional in-person health care delivery system. Growth in the use of telehealth creates new challenges and opportunities for implementation in clinical practice. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) assembled an expert group to develop a white paper to examine telehealth innovation in Physical Medicine and Rehabilitation (PM&R). The resultant white paper summarizes how telehealth is best used in the field of PM&R while highlighting current knowledge deficits and technological limitations. The report identifies new and transformative opportunities for PM&R to advance translational research related to telehealth and enhance patient care.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Joshua J Alexander
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Marcalee Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Thiru M Annaswamy
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Conley J Carr
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Philip Chang
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Mary A Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Stephen B Lewis
- Physiatry-Pharmacy Collaborative, NJ Institute for Successful Aging, Princeton, New Jersey, USA
| | - Carolyn Millett
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | | | | | - Robert Rinaldi
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Megan Roop
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Gene Tekmyster
- Department of Orthopedic Surgery, Keck Medicine of USC, Los Angeles, California, USA
| | | | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Richard D Zorowitz
- Department of Rehabilitation Medicine, MedStar National Rehabilitation Network, Georgetown University, Washington, District of Columbia, USA
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11
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Panattoni G, Monzo L, Gugliotta M, Proietti G, Tatangelo M, Jacomelli I, Zimbardo G, Meringolo F, Fedele E, Calò L. Optimal management of patients after acute coronary syndrome. Eur Heart J Suppl 2023; 25:C84-C89. [PMID: 37125273 PMCID: PMC10132559 DOI: 10.1093/eurheartjsupp/suad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Patients with clinically established atherosclerotic cardiovascular disease are at a very high risk of recurrent cardiovascular events. An adequate management of risk factors and the implementation of healthy behaviours significantly decrease the risk of unfavourable clinical outcomes and future cardiovascular events, including death. Patients discharged after an acute coronary syndrome should be managed according to their individual risk level in order to ensure the appropriate treatment. Nevertheless, care pathways should also take into consideration the available resources and the logistical/structural aspects. In this setting, cardiac rehabilitation is prosed as a multidisciplinary approach to improving daily function and reducing cardiovascular risk factors. The organization of a network with the involvement of different medical and non-medical figures is essential to ensure successful outcomes and expected cost-effectiveness.
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Affiliation(s)
| | - Luca Monzo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
- Centre d' Investigations Cliniques Plurithématique, Université de Lorraine INSERM, 5 Rue du Morvan, 54500 Vandœuvre-lès-Nancy, Francia
| | - Maria Gugliotta
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Giulia Proietti
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Mario Tatangelo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Ilaria Jacomelli
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Giuseppe Zimbardo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Federica Meringolo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
- Department of Biomedical Sciences, Faculty of Medicine, Catholic University “Our Lady of Good Counsel”, Rr. Dritan Hoxha 1000, Tirana, Albania
| | - Elisa Fedele
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
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12
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Cardiac telerehabilitation with long-term follow-up reduces GlycA and improves lipoprotein particle profile: A randomised controlled trial. Int J Cardiol 2022; 369:60-64. [DOI: 10.1016/j.ijcard.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/21/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022]
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13
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The Effect of Cardiac Rehabilitation on Lipid Levels in Patients with Coronary Heart Disease. A Systematic Review and Meta-Analysis. Glob Heart 2022; 17:83. [PMID: 36578919 PMCID: PMC9717003 DOI: 10.5334/gh.1170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Cardiac rehabilitation (CR) is a multidisciplinary medical program. Most studies have emphasized the effect of exercise-based CR in lowering lipid levels; however, the effect of CR as a comprehensive program on lipid levels remains unclear. Methods Electronic database were searched up to 2022. Randomized controlled trials with lipid profile indicators were included. Standardized mean differences (SMDs) and 95% CIs were used to evaluate the effect size. Begg's funnel plot and Egger's linear regression test were used to assess publication bias. Results CR remarkably reduced low-density lipoprotein cholesterol (LDL-C) levels (SMD = -0.23; 95%CI: [-0.38, -0.08]; P < 0.001), triglyceride (TG) levels (SMD = -0.17; 95%CI: [-0.28, -0.06]; P < 0.001), and total cholesterol (TC) levels (SMD = -0.30; 95%CI: [-0.43, -0.16]; P < 0.001) and increased high-density lipoprotein cholesterol (HDL-C) levels (SMD = 0.19; 95%CI: [0.10, 0.29]; P < 0.001). Conclusions CR reduce TC, TG, and LDL-C levels while improving HDL-C levels. CR should be promoted and more trials should be conducted for long-term CR.
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