Cardiac rehabilitation has been shown to be a cost-effective treatment in reducing mortality and morbidity in patients with acute myocardial infarction or other heart diseases. However, the uptake of this evidence-based therapy is unfortunately low in Hong Kong and other parts of the world. The uptake rate is commonly 10-20%. Furthermore, amidst the COVID-19 infection pandemic, eligible patients have been deprived of participation in hospital-based Phase II cardiac rehabilitation programs for the sake of infection control.
With advancement in mobile and communication technology, home-based tele-rehabilitation for cardiac patients has become an option. Nonetheless, there is a scarcity of data in this emerging area of service delivery. A pilot program on home-based tele-rehabilitation for cardiac patients has therefore been started in Princess Margaret Hospital since October 2020. Low risk cardiac patients, namely ischaemic heart disease with complete revascularization, valvular heart disease after interventional or surgical treatment, class I or II heart failure and cardiac arrhythmias after device implantation, are eligible for recruitment. Patients have to be able to use digital technology including smartphone or smartwatch. All patients undergo a 12-week home-based tele-rehabilitation program composed of exercise training, education sessions and relaxation therapy. Phone follow-up of patients are performed according to preset schedule. Patients attend the Cardiac Rehabilitation Clinic before and after the program for full assessment.
An interim review of the program was performed in April 2021. A total of 122 patients were screened with 49 (40.2%) successfully recruited. 9 patients withdrew from the program and the program uptake rate was thus 32.8%. 17 patients have completed the program. In these 17 patients, 6-minute walk distance significantly increased after completion of the program (437.9±70.4 vs 498.4±59.7, p< 0.001). There was an increase in the exercise self-efficacy as measured by the CESEI questionnaire (67.2±7.2 vs 70.5±6.5, p=0.124) but not reaching statistical significance. Similarly, there was an increase functional capacity as measured by the SAS questionnaire (7 METS functional capacity: 58.8 vs 87.5%, p=0.179) but not reaching statistical significance. No adverse event was reported.
Home-based tele-rehabilitation for cardiac patients is feasible. Interim data analysis has shown satisfactory uptake rate and improvement in exercise capacity in patients completing the program. Home-based tele-rehabilitation has remarkable potential in expanding the proportion of cardiac patients participating in exercise-based rehabilitation program. More data on effectiveness and safety is eagerly awaited.
