The effectiveness of structured telephone support in the late phase of rehabilitation at home in patients with myocardial revascularization
Authors: Cazacu J , Bursacovschi D , Lisii D , Vataman E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Institute of Cardiology

Background
Nowadays remote monitoring seems to be a promising solution for the surveillance of patients with chronic heart disease.

Purpose
Assessing the impact of structured telephone support in the late phase of home rehabilitation in patients with myocardial revascularization.

Methods
The study included 180 patients (mean age- 63.0±0.4 years, 75.6% were men, mean follow up duration- 28.8±0.5 months), discharged after completing the cardiac rehabilitation program after myocardial revascularization by coronary artery bypass grafting (81.7%) or percutaneous coronary angioplasty (18.3%). All subjects were divided into 2 groups. STS-Gr included 84 patients (mean age- 63.2±0.7 years, 69.8%- men, mean follow up- 30.5±1.1 months). In this group remote monitoring was applied through Structured Telephone Support - patients being contacted by telephone regularly with the issuance of recommendations for the correction of treatment and risk factors. Non-STS-Gr included 96 patients (mean age- 62.8±0.5 years, 78% being men, mean follow up- 28.1±0.6 months), who were not remotely monitored. At the discharge from the hospital and at the end of the surveillance, all patients underwent echocardiographycal examination, assessement of NT-proBNP level and evaluation of quality of life by SF-36 questionnaire.

Results
The two groups of patients were comparable in terms of NYHA functional class of heart failure, cardiovascular and non-cardiovascular comorbidities, type of myocardial revascularization. At the follow up visit, in the general group was observed a significant increase in left ventricular ejection fraction by 4.3% (p&lt;0.05) and a decrease in NT-proBNP level (-935.9±357.7, p&lt;0.05), with similar dynamics in both groups. The rate of cardiovascular (CV) hospitalization in the general group during surveillance was 51.2%. In STS-Gr the CV-hospitalization rate was significantly lower compared to non-STS-Gr (47% vs 61.2%, p &lt;0.01). The mortality rate in the general group was 7.8% and did not differ between STS-Gr and non-STS-Gr (7.5% vs 7.9%). The quality of life of patients in the general group attested a statistically important increase of the physical composite score compared to the initial data (+32.3, p&lt;0.001). The physical composite score did not show significant differences between groups at the end of the study (STS-Gr-188.2±10.2, non-STS-Gr- 194.7±7.3). At the initial stage, the mental composite score was significantly lower in STS-Gr (198.6±14.8 vs 239.6±10.6, p&lt;0.05). In contrast, at the end of surveillance, the mean value of the mental composite score in STS-Gr was higher than in non-STS-Gr (246.4±7.9 vs 224.9±5.7, respectively, p&lt;0.05).

Conclusions
Structured telephone support has been shown to be effective in reducing the rate of cardiovascular hospitalization and improving the SF-36 mental composite score of patients in the late phase of home rehabilitation after myocardial revascularization, but has not influenced mortality.