Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial

• Published in: Heart (British Cardiac Society) Vol. 105; no. 2; pp. 122 - 129
• Main Authors: Maddison, Ralph, Rawstorn, Jonathan Charles, Stewart, Ralph A H, Benatar, Jocelyne, Whittaker, Robyn, Rolleston, Anna, Jiang, Yannan, Gao, Lan, Moodie, Marj, Warren, Ian, Meads, Andrew, Gant, Nicholas
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.01.2019; BMJ Publishing Group
• Series: Original research article
• Subjects: Angina pectoris; Cardiac Risk Factors and Prevention; Cardiovascular disease; Clinical trials; Communication; Coronary Disease - economics; Coronary Disease - rehabilitation; Cost-Benefit Analysis; Costs; Education; Exercise; Exercise Therapy - economics; Exercise Therapy - methods; Female; Fitness training programs; Heart; Humans; Internet; Intervention; Male; Middle Aged; Mortality; New Zealand; Objectives; Outpatient care facilities; Physical fitness; Physiology; Quality of Life; Rehabilitation; Rehabilitation Centers; Smartphones; Software; Telemedicine; Telemedicine - methods; Treatment Outcome; New Zealand; coronary artery disease; cardiac rehabilitation; ehealth/telemedicine/mobile health
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2018-313189

ObjectiveCompare the effects and costs of remotely monitored exercise-based cardiac telerehabilitation (REMOTE-CR) with centre-based programmes (CBexCR) in adults with coronary heart disease (CHD).MethodsParticipants were randomised to receive 12 weeks of telerehabilitation or centre-based rehabilitation. REMOTE-CR provided individualised exercise prescription, real-time exercise monitoring/coaching and theory-based behavioural strategies via a bespoke telerehabilitation platform; CBexCR provided individualised exercise prescription and coaching via established rehabilitation clinics. Outcomes assessed at baseline, 12 and/or 24 weeks included maximal oxygen uptake (V̇O2max, primary) modifiable cardiovascular risk factors, exercise adherence, motivation, health-related quality of life and programme delivery, hospital service utilisation and medication costs. The primary hypothesis was a non-inferior between-group difference in V̇O2max at 12 weeks (inferiority margin=−1.25 mL/kg/min); inferiority margins were not set for secondary outcomes.Results162 participants (mean 61±12.7 years, 86% men) were randomised. V̇O2 max was comparable in both groups at 12 weeks and REMOTE-CR was non-inferior to CBexCR (REMOTE-CR-CBexCR adjusted mean difference (AMD)=0.51 (95% CI −0.97 to 1.98) mL/kg/min, p=0.48). REMOTE-CR participants were less sedentary at 24 weeks (AMD=−61.5 (95% CI −117.8 to −5.3) min/day, p=0.03), while CBexCR participants had smaller waist (AMD=1.71 (95% CI 0.09 to 3.34) cm, p=0.04) and hip circumferences (AMD=1.16 (95% CI 0.06 to 2.27) cm, p=0.04) at 12 weeks. No other between-group differences were detected. Per capita programme delivery (NZD1130/GBP573 vs NZD3466/GBP1758) and medication costs (NZD331/GBP168 vs NZD605/GBP307, p=0.02) were lower for REMOTE-CR. Hospital service utilisation costs were not statistically significantly different (NZD3459/GBP1754 vs NZD5464/GBP2771, p=0.20).ConclusionREMOTE-CR is an effective, cost-efficient alternative delivery model that could—as a complement to existing services—improve overall utilisation rates by increasing reach and satisfying unique participant preferences.