Cardiac telerehabilitation, a feasible and easy alternative in the isquemic patient: a 18-month follow-up study
Authors: Calvo Lopez M , Arranz Tolos R , Marin J , Saura Araguas J , Gruosso D , Cruz R , Gudino J C , Falces Salvador C , Roque Moreno M , Andrea Riba R , Garcia-Alvarez A , Sitges Carreno M , Sanz-De La Garza M 
Published: June 2024

Abstract

Introduction
Phase II Cardiac rehabilitation programs (CRP) decrease morbidity and mortality after acute coronary syndromes (ACS). However, in a high percentage of patients, this beneficial effect is reduced if the intervention is stopped. Besides, presence-based programs are complex and expensive, and telematic approach could be equally effective and long-lasting.

Purpose
to evaluate the safety and efficacy of a 8-week telematic CRP after ACS at the end of CRP and at 18-months follow-up. To identify the predictors of low adherence to exercise training (ET) if the intervention is discontinued.

Methods
patients who had suffered an ACS event in the previous 3 months, of both sexes, with LVEF &gt;40%, Killip I-II and accessibility to Internet were included. The Phase II 8-week telematic CRP was conducted via a specific designed platform. The CRP included two ET sessions a week (aerobic and strength) and one educational session a week (healthy lifestyle and emotional support). Emotional state, functional capacity, adhesion to Mediterranean diet and lipid profile were evaluated at baseline and after the end of the CRP. ET weekly volume was calculated by the IPAQ questionaire. In patients that maintained or improved the ET volume after the CRP, a third evaluation at 18-month follow-up was additionally performed.

Results
Between January and December of 2021, fifty patients (85% male) completed the Phase II CRP. The CRP promoted a significant improvement in functional capacity, muscle strength, weekly training volume, lipid profile, adherence to Mediterranean diet, emotional state and quality of life (Figure 1A-C). There were no complications and patient’s adherence was excellent for both exercise (85%) and educational (80%) sessions. At 18-month follow-up, 18 patients (36%) maintained or increase ET volume. In these patients the beneficial impact of the CRP on functional capacity, muscle strength, lipid profile and adherence to Mediterranean diet continued, while anxiety and depression symptoms improved even further. 32 patients (64%) reduced their ET volume or stopped training. At baseline, these patients had comparatively worse metabolic control and had greater smoking burden. Furthermore, the beneficial impact of the CRP in terms of quality of life, emotional state and ET level was less and their satisfaction towards the CRP and their adherence to ET and educational sessions were lower (Figure 2).

Conclusion
A holistic telematic CRP after ACS was safe and effective in improving functional capacity, emotional state and adherence to healthy lifestyle at short time. This beneficial impact was maintained after 18-month follow-up in patients that continued ET. However, 64% of patients reduced their ET levels. These patients presented worse metabolic profile, higher levels of anxiety, were less adherent to CRP and the positive impact of CRP was lower. These results claim the need for extended intervention in patients with this profile. Figure 1(A,B,C). Figure 2