Abstract
Background
The PROspective MulticEnter registry in patients with acuTely dEcompensated heart failure admitted to cardiac rehabilitatiOn (PROMETEO) is currently ongoing in four Italian facilities. As part of the project, a home-based telerehabilitation program (HBTR) on top of center-based cardiac rehabilitation (CBCR) is offered to all patients.
Aim of the study
To describe HBTR delivered by a specifically designed digital solution, together with ad interim evaluation for feasibility.
Methods
Provision of digital-based HBTR activities and current estimates of uptake and completion rates.
Results
HBTR is organized at the end of CBCR (Figure 1), according to clinical and functional data, and ensuring goals and activities. Exclusion criteria are represented by patient's refusal and unsolved logistic barriers (e.g. no possibility of home training, digital illiteracy, low socio-economic condition, planned re-hospitalization). A Service Centre (SC), composed of trained physiotherapists and strictly linked to the CBCR facility, performs synchronous training activities as far as organization of asynchronous sessions, both for the aerobic and strength training domains, with own digital platform for remotely supervision of patients. Home exercise is supported by dedicated equipment (i.e. cyclette or treadmill) temporary released to patients, devices for heart rate/oxygen saturation monitoring, and EKG/accelerometry. Participants are provided a dedicated App for individual programs (Figure 2), which is a CE-certificated IIa class medical device, and two wearable fitness trackers to self-manage their activity and share data. The app is viewable on a dedicated tablet device. Participants receive a weekly telehealth-based visit from the physiotherapist, providing up- or downregulation of the exercise program in terms of structured education supported by multimedia contents. Patients are able to self-log exercise activity, vital signs, and medication adherence, as well as receive reminders for session execution via the app. An integrated online case management dashboard serves for all patient and coach activities. The SC personnel performs one-shot home supervision within the 1st month from the HBTR start, as far as additional home supervisions prescribed by the cardiologist at the CBCR facility. To date, the uptake rate of HBTR is 1 out of 6 patients at the end of CBCR, and main reason for no referral is represented by logistic barriers, despite strong support for activities adjustment at home. Actual completion rate is 100% among 12 initially treated patients.
Conclusions
Advanced digital solutions may be useful after traditional CBCR, also in patients at very high risk of re-hospitalization and deterioration of functional capacity/quality of life, such as those after acute heart failure.
