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An update on home-based cardiac rehabilitation

Comment by Maria Simonenko, Secondary Prevention and Rehabilitation Section

Rehabilitation and Sports Cardiology
Risk Factors and Prevention

The prevalence of coronary heart disease and heart failure is increasing, and there is some evidence of the health benefits of cardiac rehabilitation [1]. Although nonparticipation in cardiac rehabilitation is known to increase cardiovascular mortality and hospital readmissions, more than half of patients with coronary artery disease in Europe are not participating in cardiac rehabilitation [1,2]. And in 2020 the number of patients who were actually referred for cardiac rehabilitation further decreased. So a new study by Snoek et al. in the current issue of EJPC assessed a 6-month guided mobile cardiac rehabilitation program and they collected results from 2015 to 2018 [2]. However, the way COVID-19 affected cardio follow-up and, especially, cardiac rehabilitation, the importance of widespread telemonitoring and guided mobile cardiac rehabilitation is clear.

In fact, in the UK formal rehabilitation is predominantly provided to supervised groups in outpatient hospital clinics or community centres, starting 2–4 weeks after percutaneous coronary intervention or myocardial infarction and usually 4–6 weeks after cardiac surgery [3]. Moreover, cardiac rehabilitation programmes in the US and Europe tend to be more intensive than those in the UK and are delivered from outpatient departments over 3–6 months. Some European countries offer residential programmes lasting 3–4 weeks. The focus is mainly on “monitored exercise and aggressive risk factor reduction” in medically supervised sessions [4,5]. In addition, Snoek et al. also looked at motivational interviewing to stimulate patients to reach exercise goals [2] and instructed them to exercise at moderate intensity for at least 30 minuted per day, 5 days per week during 6 months [2].

This agrees with a statement by the AHA and ACC from 2019, which suggests that the use of long-term home-based cardiac rehabilitation could help to improve long-term adherence to the therapies initiated in the earlier post-cardiovascular event phase [6]. At the same time, Snoek et al report a low incidence of adverse events, which did not differ between the monitoring cardiac rehabilitation and control groups [2]. According to Snoek et al. results, a 6-month home-based mobile cardiac rehabilitation program for patients 65 years or older with coronary artery disease or a valvular intervention was safe and beneficial in improving VO2peak when compared with no cardiac rehabilitation [2]. While Snoek et al. focused on elderly patients [2], future studies need to look at specific means of cardiac rehabilitation for other specific populations, such as patients with congenital heart disease (CHD), where there is still lack of information [7,8].

In 2020 the world has changed a lot, virtual meetings and digital education became more frequent as a solution to travel limitations and to avoid crowding of meeting rooms. However, rehabilitation was not initially a main application of digital technology - a problem as patients were isolated at home and were limited to receive on-site cardiac rehabilitation. So future perspectives should also focus on promoting home-based cardiac rehabilitation and the key is to give an access to our patients to participate in it and to explore the long-term benefits of telerehabilitation.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology


Maria Simonenko commented on this article:

2. Johan A. Snoek, Eva I. Prescott, Astrid E. van der Velde, Thijs M. H. Eijsvogels, Nicolai Mikkelsen, Leonie F. Prins, Wendy Bruins, Esther Meindersma, José R. González-Juanatey, Carlos Peña-Gil, Violeta González-Salvado, Feriel Moatemri, Marie-Christine Iliou, Thimo Marcin, Prisca Eser, Matthias Wilhelm, Arnoud W.J. Van’t Hof, Ed P. de Kluiver - Effectiveness of Home-Based Mobile Guided Cardiac Rehabilitation as Alternative Strategy for Nonparticipation in Clinic-Based Cardiac Rehabilitation Among Elderly Patients in Europe: A Randomized Clinical Trial, JAMA Cardiology, 2020; DOI: 10.1001/jamacardio.2020.5218

Additional references:

1. Hasnain M. Dalal, Patrick Doherty, Rod S. Taylor – Cardiac rehabilitation, BMJ, 2015; 351: h5000. DOI: 10.1136/bmj.h5000
3. H. Bethell, R. Lewin, H. Dalal - Cardiac rehabilitation in the United Kingdom, Heart, 2009; 95:271-5 DOI: 10.1136/hrt.2007.134338
4. Warner M. Mampuya - Cardiac rehabilitation past, present and future: an overview, Cardiovascular Diagnosis & Therapy, 2012; 2:38-49 DOI: 10.3978/j.issn.2223-3652.2012.01.02
5. Arthur R. Menezes, Carl J. Lavie, Richard V. Milani, Daniel E. Forman, Marjorie King, Mark A. Williams - Cardiac rehabilitation in the United States, Prog Cardiovasc Dis, 2014; 56(5): 522-9 DOI: 10.1016/j.pcad.2013.09.018
6. R.J. Thomas, A.L. Beatty, T.M. Beckie, L.C. Brewer, T.D. Brown, D.E. Forman, B.A. Franklin, S.J. Keteyian, D.W. Kitzman, J.G. Regensteiner, B.K. Sanderson, M.A. Whooley – Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonery Rehabilitation, the American Heart Association, and the American College of Cardiology, 2019; 140: e69-e89 DOI: 10.1161/CIR.000000000000663
7. Joseph Tessler, Bruno Bordoni – Cardiac rehabilitation, StatPearls [Internet], Treasure Island (FL): StatPearls Publishing, 2020. PMID: 30725881
8. Pascal Amedro, Arthur Gavotto, Charlene Bredy, Sophie Guillaumont - Cardiac rehabilitation for children and adults with congenital heart disease, Presse Med, 2017; 46(5): 530-537 DOI: 10.1016/j.lpm.2016.12.001

Notes to editor

Maria Simonenko, Almazov National Medical Research Centre, St. Petersburg, Russia