## 4 Discussion
(2005) assessed 30 HF patients who underwent 4 months of hospital-based exercise training followed by 8 months of home-based telemonitoring with heart rate monitors (downloaded bimonthly), exercise diaries and weekly telephone contact, cardiac rehabilitation program. Only adherent patients (50%) showed persistent improvement of physical capacity and quality of life at 12 months [23]. In our study, the multidisciplinary telemedicine intervention was completed after 9 weeks and was not extended in the long-term follow-up. Nevertheless, it has proved effective in improving the prognosis in HF patients in long-term follow-up [17]. [PERSON] et al. (2017) randomized 53 HF patients to 12 weeks (twice weekly) home-based telerehabilitation or standard rehabilitation group with follow-up of the next 12 weeks. The authors found that the 6 min walk test distance and quality of life changes after both models of rehabilitation improved significantly. Nevertheless, this improvement did not maintenance during the next 12 weeks of unsupervised exercise phase at follow-up. Regarding adherence to exercise training, significantly higher attendance rates were observed in the home-based telerehabilitation group. There were 71% vs. 30% adherent patients, 29% vs. 63% partly adherent patients, 0% vs. 7% non-adherent patients in the telerehabilitation group in comparison to the standard rehabilitation group, respectively [24]. These adherence results are in line with those obtained in our study. However, we did not assess physical capacity in long-term follow-up. In the Telechehab III trial by [PERSON] et al. (2015), 140 patients were randomized to an Internet-based comprehensive telerehabilitation program in addition to conventional central-based rehabilitation or conventional central-based rehabilitation alone. This study demonstrated that a 24-week tailored telerehabilitation initiated 6 weeks after the start of conventional rehabilitation led to a bigger physical capacity improvement, measured by peak VO\({}_{2}\). The number of days lost due to cardiovascular rehospitalizations in the telerehabilitation group was significantly lower than in the standard rehabilitation group in one-year follow-up after study termination [25]. Our study showed a reduction in HF rehospitalization rates only in the adherent group patients. It is worth noting that the population of the Telechehab III study differed from that randomized to our study, while in the Telechehab III trial, only 3% of patients had HF with reduced ejection fraction [25]. Additionally, the authors did not evaluate adherence in detail. In the context of HF patients' adherence to rehabilitation programs, it is worth citing the HF-ACTION study, bearing in mind that the methodology, the intervention, and the follow-up protocol are completely different from the TELEREH-HF trial. In the HFACTION trial, 2331 HF patients were randomized either to an aerobic exercise training group or a usual care group in order to determine whether the intervention is able to improve physical capacity and quality of life and to reduce all-cause mortality or all-cause hospitalization. The results showed that exercise training led only to a non-significant 7% reduction in all-cause mortality or all-cause hospitalization after a median follow-up of 30 months. Although after adjustment for prespecified prognostic factors, the composite primary endpoint was significantly reduced by 11% [26]. Contrary to our results, there was only 26% full adherent to exercise training patients, 15% partial adherent patients, and 59% poor adherent patients [26]. However, the intervention in the TELEREH-HF trial was much shorter, and exercise training at home was remotely monitored. Similarly, to our study, in the HF-ACTION trial, there was no association between exercise adherence and the primary outcome of all-cause death or hospitalization. However, compared with full adherence, poor adherence was associated with a higher risk of cardiovascular death or HF hospitalization [25; 26]. These findings were confirmed by our study.