effectiveness of a cardiac telerehabilitation program in chronic heart failure

Conditions: Heart Failure

Summary: the goal of this observational study is to evaluate whether a home-based cardiac tele-rehabilitation program can improve functional capacity in adults (18 years and older) with chronic heart failure. the main questions it aims to answer are: does tele-rehabilitation improve peak oxygen uptake (vo₂ max) compared to standard in-hospital rehabilitation? does it improve cardiac function, exercise tolerance, biochemical markers, and quality of life? are functional gains maintained at 24 weeks? researchers will compare patients who opt for tele-rehabilitation using wearable devices and a remote monitoring platform with those undergoing standard in-person rehabilitation. participants will follow an 8-week individualized training program and undergo assessments at baseline, 4, 8, 16, and 24 weeks.

this is a prospective, single-center, non-pharmacological observational study designed to assess the effectiveness of a structured home-based cardiac tele-rehabilitation program in patients with chronic heart failure (chf). the study aims to determine whether tele-rehabilitation is comparable or superior to standard in-hospital cardiac rehabilitation in improving patients' functional capacity, as measured by peak oxygen uptake (vo₂ max), and secondary health-related outcomes. participants will be adults diagnosed with chf, already on optimized medical therapy, and eligible for cardiac rehabilitation. based on their voluntary choice, they will be allocated to either a tele-rehabilitation group or a conventional in-hospital rehabilitation group. both groups will follow the same 8-week exercise training protocol, which includes interval and endurance components based on international guidelines. however, the tele-rehabilitation group will perform the program at home using a certified telemonitoring platform and wearable sensors, under real-time remote supervision by physiotherapists. data collection will include clinical, functional, biochemical, and quality-of-life assessments at multiple time points (baseline, 4, 8, 16, and 24 weeks). the primary outcome is the change in vo₂ max at 8 weeks. secondary outcomes include changes in echocardiographic parameters, exercise tolerance, biomarkers (e.g., bnp, anp), and quality-of-life scores (e.g., sf-36, kccq-12), as well as maintenance of functional gains at follow-up. the study also evaluates adherence, safety, and usability of the tele-rehabilitation system. no experimental drugs or additional diagnostic procedures beyond standard care are involved. the findings will inform the integration of tele-rehabilitation into standard chf management and support scalable care models for chronic disease.

Eligibility criteria:
inclusion criteria: * age ≥ 18 years * diagnosis of chronic heart failure for at least 6 months, with stable optimal medical therapy for at least 1 month * nyha class i, ii, or iii * hospitalization or outpatient visit requiring intravenous therapy (diuretics, vasodilators, or inotropes) within the past 12 months * ability to provide informed consent or presence of a legal representative * digital literacy of the patient and/or caregiver exclusion criteria: * age \< 18 years * pregnancy * nyha class iv heart failure * severe renal insufficiency (egfr \<30 ml/min/1.73 m²) or on dialysis * other serious illnesses significantly limiting life expectancy (e.g., end-stage cancer, advanced pulmonary disease)

Keywords: chronic heart failure cardiac rehabilitation tele-rehabilitation telemedicine exercise training remote monitoring mhealth wearable sensors home-based rehabilitation digital health