Participation in cardiac telerehabilitation
Authors: Houben V , Rikken AOF , Castro Conde A , Gomes Doblas J , Lozano Torres J , Hoorntje C , Van 'T Hof AWJ 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EIT Health Campus
Rationale
Cardiac rehabilitation (CR) programmes are successful in educating patients and lowering their cardiovascular (CV) risk. However attendance before COVID was between 8 and 50%. Because of short duration of CR programmes sustainability in behaviour change is often suboptimal. The COVID pandemic has shown us the need for high quality remote CR.
Mobile guided CR (mCR) has proven to be equally effective as centre-based CR and has the potential to increase participation rates. It also provides possibilities to extend the CR programme.
Extending CR programmes with ehealth solutions have shown mixed results on sustainable behaviour change. It is still unknown what type of patients prefer mCR above regular CR when offered as standard care.
REHAB+
Rehab+ is a mobile CR program, offered for one year to patients after myocardial infarction as an alternative to the regular CR program. It offers an optimised digital platform and regular interaction with the healthcare team. Patients are able to measure and register physical activity, heart frequency and intensity (BORG scale) and can monitor progress. A care professional (coach) also has access to a portal to monitor progress of different patients, advice on rehabilitation approach and stimulate compliance. Rehab+ is co-created with patients and rehab centres. In 2022, it will conclude its pilot and evaluation in 4 centres (Spain and the Netherlands), and scaled to more in the EU.

Objectives
1. To assess whether mCR programmes result in better sustained effects, as compared to the regular CR programme.
2. To explore what type of patients prefer mCR above a regular CR programme.
Study population
900 Post myocardial infarction patients (300 mCR, 600 regular CR) who are indicated for CR. (See figure 1) Patients not able or willing to participate will be registered in an exclusion log. mCR patients will be coached for 12 months with decreasing amounts of touchpoints. Regular CR patients receive no coaching after the end of the regular CR program.
Study design
Prospective, matched control observational trial
Follow-up
Patients will be monitored at (see table 1):
- T0: baseline characteristics, exercise test, laboratory tests, Fägerstrom test, IPAQ questionnaire, SF-36 questionnaire
- T1 (3 months): Physical exam, medication, ECG, laboratory tests, adherence and compliance (mCR only),Fägerstrom test, IPAQ questionnaire, SF-36 questionnaire, eHIQ questionnaire
- T2 (12 months): Physical exam, medication, ECG, laboratory tests, exercise test, adherence and compliance (mCR only),Fägerstrom test, IPAQ questionnaire, SF-36 questionnaire, eHIQ questionnaire

Conclusion
Inclusion will start in November 2021. The results of this study will give insight in what type of patients choose to participate in mCR. With this information mCR programmes can be further optimised and adjusted. It may help to further increase participation rates in CR.