Comparison of patient characteristics and health outcomes between self-selected centre-based cardiac rehabilitation and hybrid cardiac telerehabilitation: a prospective cohort study.

Abstract

Aims Data on self-selected modes of delivery of cardiac rehabilitation (CR) are limited. This study compared centre-based CR (cbCR) with hybrid cardiac telerehabilitation (hCTR) in terms of patient characteristics, change in physical and mental functioning, and achievement of guideline-directed treatment targets.Methods And Results From May 2022 to December 2023, consecutive patients with cardiovascular diseases were enrolled at a tertiary centre into a 3 month cbCR or hCTR programme based on shared decision-making. Changes in exercise capacity, anxiety, depression, and health-related quality of life (hrQoL) scores from admission to the discharge visit were compared between CR modalities. The achievement of two-step blood pressure and LDL-cholesterol (LDL-C) goals, as well as the HbA1c goal in patients with diabetes at the discharge visit, was compared between CR modalities. Out of 1292 patients screened, 406 (21% females, age 60.4 ± 12.7 years) were eligible and completed the study. Of those, 72% chose cbCR and 28% chose hCTR. Patients in hCTR were 3 years younger and exhibited higher baseline peak VO2 (91 vs. 80% of predicted), better hrQoL, and lower depression and anxiety scores. No significant differences were found in improvements in physical or mental functioning or in meeting blood pressure and HbA1c targets between the two groups. A smaller proportion of hCTR participants achieved the LDL-C Step I target (56 vs. 69% in cbCR).Conclusion Overall, hCTR attracted slightly younger patients with better baseline health, but both modalities showed similar effects on most health outcomes. Centre-based cardiac rehabilitation was associated with tighter lipid control, which could be related to more intense counselling or patient preference.Outpatient cardiovascular rehabilitation was equally effective when performed with thrice weekly supervised exercise training sessions or partly performed at home while monitored with fitness trackers and a biosensor vest. Patients who self-select digitally monitored home training were slightly younger, fitter, and had better quality of life with lower levels of anxiety and depression. Blood lipid control, weight loss, and smoking cessation therapies need to be enhanced by tighter control and more intensive medical therapy particularly in patients choosing to perform part of the exercise sessions at home.