Home‐based cardiac rehabilitation using information and communication technology for heart failure patients with frailty

• Published in: ESC Heart Failure 2022-08, Vol.9 (4), p.2407-2418
• Main Authors: Nagatomi, Yuta, Ide, Tomomi, Higuchi, Tae, Nezu, Tomoyuki, Fujino, Takeo, Tohyama, Takeshi, Nagata, Takuya, Higo, Taiki, Hashimoto, Toru, Matsushima, Shouji, Shinohara, Keisuke, Yokoyama, Tomiko, Eguchi, Aika, Ogusu, Ayumi, Ikeda, Masataka, Ishikawa, Yusuke, Yamashita, Fumika, Kinugawa, Shintaro, Tsutsui, Hiroyuki
• Format: Article
• Language: English
• Subjects: Aerobics; Body mass index; Cardiac rehabilitation; Cardiology; Cardiovascular disease; Communication; Dietitians; Ergometry; Exercise intensity; Exercise tolerance; Frailty; Heart failure; Home rehabilitation; Hospitals; Information technology; Intervention; Kidney diseases; Nutrition; Original; Participation; Patient education; Physical fitness; Physical therapists; Rehabilitation; Smartphones; Strength training; Telemedicine; Weight control
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.13934

Aims Cardiac rehabilitation (CR) is an evidence‐based, secondary preventive strategy that improves mortality and morbidity rates in patients with heart failure (HF). However, the implementation and continuation of CR remains unsatisfactory, particularly for outpatients with physical frailty. This study investigated the efficacy and safety of a comprehensive home‐based cardiac rehabilitation (HBCR) programme that combines patient education, exercise guidance, and nutritional guidance using information and communication technology (ICT). Methods and results This study was a single‐centre, open‐label, randomized, controlled trial. Between April 2020 and November 2020, 30 outpatients with chronic HF (New York Heart Association II–III) and physical frailty were enrolled. The control group (n = 15) continued with standard care, while the HBCR group (n = 15) also received comprehensive, individualized CR, including ICT‐based exercise and nutrition guidance using ICT via a Fitbit® device for 3 months. The CR team communicated with each patient in HBCR group once a week via the application messaging tool and planned the training frequency and intensity of training individually for the next week according to each patient's symptoms and recorded pulse data during exercise. Dietitians conducted a nutritional assessment and then provided individual nutritional advice using the picture‐posting function of the application. The primary outcome was the change in the 6 min walking distance (6MWD). The participants' mean age was 63.7 ± 10.1 years, 53% were male, and 87% had non‐ischaemic heart disease. The observed change in the 6MWD was significantly greater in the HBCR group (52.1 ± 43.9 m vs. −4.3 ± 38.8 m; P