ROME – A home-based cardiac rehabilitation program that relies on telemonitoring safely allowed effective training of about 800 elderly cardiac patients at one center in Poland since 2006.
"The advantages of telerehabilitation are the convenience and easy access for elderly patients," Dr. Ewa Piotrowicz said at the annual meeting of the European Association for Cardiovascular Prevention and Rehabilitation*. Telerehabilitation "fosters greater patient independence than hospital-based exercise training, and may reduce patient commute time and costs. Telemedicine may overcome some of the barriers related to aging.
"In our opinion, home-based cardiac rehabilitation is the best option" for older patients, said Dr. Piotrowicz, a cardiologist and head of the telecardiology center of the Institute of Cardiology in Warsaw.
A key to safe and successful home-based rehabilitation training for elderly cardiac patients is a thorough baseline examination to assess cardiac stability. "We don’t do telerehabilitation on unstable patients," she said in an interview. The other major feature is thorough monitoring by a telephone conversation and telephone transmission of vital recordings immediately before and after each at-home rehabilitation session. "Before and after every session the patient sends an ECG recording and answers a series of questions," she explained.
During the 7 years that the institute has run the program, it has enrolled about 500 lower-risk and 300 higher-risk patients, with about 50 in the program at any given time. At entry, each patient undergoes assessment by ECG, an echocardiography examination, 24-hour Holter blood pressure monitoring, and a cardiopulmonary exercise test.
The rehabilitation program involves an individualized exercise training program, and launches with a few sessions at the hospital along with educational sessions. The patient then continues the basic phase of the program with five daily sessions per week for 8 weeks. The program includes walking, running, interval training, and breathing training. Before and immediately after each daily session the patient speaks with a physician at the center, answering questions and sending information on ECG, heart rate, blood pressure, weight, oxygen saturation, respiration rate, and medications taken. Patients must receive approval from a physician before each exercise session starts.
The program achieved a high compliance level. Dr. Piotrowicz said that 95% of the 800 participants completed their 8-week programs. Following that, patients are encouraged to continue exercising on their own.
In 2010, she and her associates reported results from a formal, controlled assessment of compliance among 152 patients with heart failure who were randomized to either a home-based, telemonitored rehabilitation program or a more conventional outpatient program. The home-based telemonitored program produced similar clinical and quality of life improvements compared with the program for the control patients, and the 77 patients randomized to telemonitoring had 100% compliance with the 8-week rehabilitation program, compared with a 20% attrition rate among the patients enrolled in a standard outpatient rehabilitation program (Eur. J. Heart Fail. 2010;12:164-71). Dr. Piotrowicz attributed the high compliance to the daily contact that patients maintain with their health care providers.
"Telerehabilitation is a chance for implementing cardiac rehabilitation, especially in chronic heart failure patients," she said. The next step is a multicenter study of this approach, she added.
Dr. Piotrowicz said that she had no disclosures.
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*Correction, 5/29/2013: An earlier version of this story misstated the name of the European Association for Cardiovascular Prevention and Rehabilitation.