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Clephas PRD, Zwartkruis VW, Malgie J, van Gent MWF, Brunner-La Rocca HP, Szymanski MK, van Halm VP, Handoko ML, Kok W, Asselbergs FW, van Kimmenade R, Manintveld O, van Mieghem NMDA, Beeres SLMA, Post MC, Borleffs CJW, Tukkie R, Mosterd A, Linssen GCM, Spee RF, Emans ME, Smilde TDJ, van Ramshorst J, Kirchhof C, Feenema-Aardema F, da Fonseca CA, van den Heuve M, Hazeleger R, van Eck M, van Heerebeek L, Boersma H, Rienstra M, de Boer RA, Brugts JJ. Pulmonary artery pressure monitoring in chronic heart failure: effects across clinically relevant subgroups in the MONITOR-HF trial. Eur Heart J 2024:ehae323. [PMID: 38733175 DOI: 10.1093/eurheartj/ehae323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND AND AIMS In patients with chronic heart failure (HF), the MONITOR-HF trial demonstrated the efficacy of pulmonary artery (PA)-guided HF therapy over standard of care in improving quality of life and reducing HF hospitalizations and mean PA pressure. This study aimed to evaluate the consistency of these benefits in relation to clinically relevant subgroups. METHODS The effect of PA-guided HF therapy was evaluated in the MONITOR-HF trial among predefined subgroups based on age, sex, atrial fibrillation, diabetes mellitus, left ventricular ejection fraction, HF aetiology, cardiac resynchronisation therapy, and implantable cardioverter defibrillator. Outcome measures were based upon significance in the main trial and included quality of life, clinical, and PA pressure endpoints, and were assessed for each subgroup. Differential effects in relation to the subgroups were assessed with interaction terms. Both unadjusted and multiple testing adjusted interaction terms were presented. RESULTS The effects of PA monitoring on quality of life, clinical events, and PA pressure were consistent in the predefined subgroups, without any clinically relevant heterogeneity within or across all endpoint categories (all adjusted interaction P-values were nonsignificant). In the unadjusted analysis of the primary endpoint quality-of-life change, weak trends towards a less pronounced effect in older patients (Pinteraction = 0.03; adjusted Pinteraction = 0.33) and diabetics (Pinteraction = 0.01; adjusted Pinteraction = 0.06) were observed. However, these interaction effects did not persist after adjusting for multiple testing. CONCLUSIONS This subgroup analysis confirmed the consistent benefits of PA-guided HF therapy observed in the MONITOR-HF trial across clinically relevant subgroups, highlighting its efficacy in improving quality of life, clinical, and PA pressure endpoints in chronic HF patients.
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Affiliation(s)
- P R D Clephas
- Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - V W Zwartkruis
- Department of Cardiology, University Medical Centre Groningen, Groningen, Netherlands
| | - J Malgie
- Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - M W F van Gent
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - H P Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - M K Szymanski
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - V P van Halm
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - M L Handoko
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - W Kok
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - F W Asselbergs
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - R van Kimmenade
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - O Manintveld
- Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - N M D A van Mieghem
- Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - S L M A Beeres
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - M C Post
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands
| | - C J W Borleffs
- Department of Cardiology, HAGA Hospital, Den Haag, Netherlands
| | - R Tukkie
- Department of Cardiology, Spaarne Hospital, Haarlem, Netherlands
| | - A Mosterd
- Department of Cardiology, Meander Medical Centre, Amersfoort, Netherlands
| | - G C M Linssen
- Department of Cardiology, Hospital Group Twente, Almelo, Netherlands
| | - R F Spee
- Department of Cardiology, Maxima Medical Centre, Veldhoven/Eindhoven, Netherlands
| | - M E Emans
- Department of Cardiology, Ikazia hospital, Rotterdam, Netherlands
| | - T D J Smilde
- Department of Cardiology, Scheeper Hospital TREANT, Emmen, Netherlands
| | - J van Ramshorst
- Department of Cardiology, Noordwest Hospital group, Alkmaar, Netherlands
| | - C Kirchhof
- Department of Cardiology, Alrijne Hospital, Leiderdorp, Netherlands
| | - F Feenema-Aardema
- Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, Netherlands
| | - C A da Fonseca
- Department of Cardiology, Medical Centre Leeuwarden, Leeuwarden, Netherlands
| | - M van den Heuve
- Department of Cardiology, Department of Cardiology, Medisch Spectrum Twente, Enschede, Netherlands
| | - R Hazeleger
- Department of Cardiology, Vie Curi Hospital, Venlo, Netherlands
| | - M van Eck
- Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - L van Heerebeek
- Department of Cardiology, OLVG Hospital, Amsterdam, Netherlands
| | - H Boersma
- Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - M Rienstra
- Department of Cardiology, University Medical Centre Groningen, Groningen, Netherlands
| | - R A de Boer
- Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J J Brugts
- Department of Cardiology, Thorax centre, Cardiovascular institute, Erasmus University Medical Center, Rotterdam, Netherlands
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2
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Van Leunen M, Spee RF, Lu Y, Kemps HMC. Telerehabilitation in patients with recent hospitalization due to acute decompensated heart failure: protocol for the Tele-ADHF randomised controlled trial. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/introduction
Cardiac rehabilitation (CR) has favourable effects in chronic heart failure (CHF) patients on exercise capacity, the risk at hospital (re-)admission and quality of life. Although CR is generally recommended, it is still under-utilized in the daily clinical practice partly due to logistics reasons, limited availability, and patient-related barriers. Cardiac telerehabilitation (CTR) could solve some of these barriers, and have the same favourable outcomes.
Purpose
The aim of this study is to investigate if CTR in recently hospitalized CHF patients improves their physical functional capacity when compared to no rehabilitation.
Methods
This randomised controlled trial compares CTR with no rehabilitation after hospitalization for acute decompensated heart failure (ADHF). 64 patients will be included during hospitalization, and start with Remote Patient Management (RPM). After a short period of stable CHF, the patients will be randomised for RPM combined with CTR (intervention group), or RPM alone (control group). The intervention group will start with an 18-weeks program with exercise training, supported by a (remote) technology-assisted dietary intervention and mental health guiding. The training program starts with three centre-based and two home-based video training sessions followed by video coaching sessions. The primary endpoint is physical functional capacity, evaluated using the Short Physical Performance Battery (SPPB) score. Secondary endpoints are recovery after submaximal exercise by evaluating VO2 recovery kinetics (τ-rec), subjective health status, health related quality of life, compliance and acceptance, and readmission rate.
Future implications
This will be the first study to use an CTR program with integrated RPM after hospitalization for ADHF.
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Affiliation(s)
- M Van Leunen
- Maxima Medical Center, Cardiology, Veldhoven, Netherlands (The)
| | - RF Spee
- Maxima Medical Center, Cardiology, Veldhoven, Netherlands (The)
| | - Y Lu
- Eindhoven University of Technology, Industrial Design, Eindhoven, Netherlands (The)
| | - HMC Kemps
- Maxima Medical Center, Cardiology, Veldhoven, Netherlands (The)
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3
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Tenbult - Van Limpt N, Van Asten I, Brouwers R, Spee RF, Brini A, Kemps HMC. Information needs and information seeking behavior in patients receiving cardiac rehabilitation. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
In Cardiac Rehabilitation (CR), education is an important element of interventions that aims to reduce the risk of new cardiovascular diseases. Previous research showed that in order to be effective, information provided by medical professionals should be tailored to the information needs of the individual patient. However, knowledge on determinants of specific information needs is scarce. Therefore, the aim of this study was to investigate the variability in information needs among participants and the determinants of information needs on lifestyle behaviour, psychological wellbeing and medication after an acute coronary event or revascularization procedure.
Methods
Patients entering the CR program for the first time following myocardial infarction (MI) and / or percutaneous coronary intervention (PCI) or coronary bypass (CABG) were instructed to complete questionnaires on (1) the level and type of information needs about nutrition, physical activity, smoking, psychological well-being and medication, (2) information seeking behaviour and (3) potential determinants of information needs (i.e., socio-demographic characteristics, level of health literacy, illness perceptions, anxiety, depression, type D personality and quality of life).
Results
259 patients were included. The mean age was 65 years, 76% of the study population was male, 58% was diagnosed with MI and 63% undergone a PCI (63%). The majority of patients (63%) indicated the need for information on at least one of the 4 topics (i.e., nutrition, physical activity, medication, psychological well-being), with considerable inter-individual variation. Gender, employment and socio-economic status, level of anxiety and illness perception were found to be significant predictors for the information needs, based on multivariable logistic regression analysis.
Conclusion
This study showed that there was a need for information in the majority of the patients with considerable inter-individual variability with respect to the topics. Whereas diagnosis was not related to the preference for specific information topics, characteristics as gender, employment, socio-economic status, anxiety and illness perception were selected as independent predictors of information needs. These results underline the need for personalized information strategies.
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Affiliation(s)
| | - I Van Asten
- Maastricht University, Maastricht, Netherlands (The)
| | - R Brouwers
- Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands (The)
| | - RF Spee
- Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands (The)
| | - A Brini
- Eindhoven University of Technology, Department of Mathematics and Computer Science, Statistics, Eindhoven, Netherlands (The)
| | - HMC Kemps
- Maxima Medical Centre, Department of Cardiology, Veldhoven, Netherlands (The)
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4
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Vromen T, Brouwers RWM, Jorstad HT, Kraaijenhagen RA, Spee RF, Wittekoek ME, Cramer MJ, van Hal JMC, Hofstra L, Kuijpers PMJC, de Melker EC, Rodrigo SF, Sunamura M, Uszko-Lencer NHMK, Kemps HM. Novel advances in cardiac rehabilitation : Position paper from the Working Group on Preventive Cardiology and Cardiac Rehabilitation of the Netherlands Society of Cardiology. Neth Heart J 2021; 29:479-485. [PMID: 34114176 PMCID: PMC8455729 DOI: 10.1007/s12471-021-01585-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 01/16/2023] Open
Abstract
Cardiac rehabilitation (CR) has evolved as an important part of the treatment of patients with cardiovascular disease. However, to date, its full potential is fairly underutilised. This review discusses new developments in CR aimed at improving participation rates and long-term effectiveness in the general cardiac population. It consecutively highlights new or challenging target groups, new delivery modes and new care pathways for CR programmes. These new or challenging target groups include patients with atrial fibrillation, obesity and cardiovascular disease, chronic coronary syndromes, (advanced) chronic heart failure with or without intracardiac devices, women and frail elderly patients. Also, the current evidence regarding cardiac telerehabilitation and loyalty programmes is discussed as new delivery modes for CR. Finally, this paper discusses novel care pathways with the integration of CR in residual risk management and transmural care pathways. These new developments can help to make optimal use of the benefits of CR. Therefore we should seize the opportunities to reshape current CR programmes, broaden their applicability and incorporate them into or combine them with other cardiovascular care programmes/pathways.
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Affiliation(s)
- T Vromen
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - R W M Brouwers
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - H T Jorstad
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - R F Spee
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - M J Cramer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J M C van Hal
- Department of Cardiology, Slingeland Hospital, Doetinchem, The Netherlands
| | - L Hofstra
- Cardiology Centres Netherlands, Utrecht, The Netherlands
| | - P M J C Kuijpers
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E C de Melker
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - S F Rodrigo
- Basalt Rehabilitation, Leiden, The Netherlands
| | - M Sunamura
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | - N H M K Uszko-Lencer
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H M Kemps
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
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5
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Brouwers R, Kraal JJ, Regis M, Spee RF, Kemps HMC. Effectiveness of cardiac telerehabilitation with relapse prevention compared to centre-based cardiac rehabilitation: results from the SmartCare-CAD randomised controlled trial. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was part of the SmartCare project, which was partially funded under the ICT Policy Support Programme (ICT PSP), grant agreement number 325158.
Background
Most studies failed to show superiority of cardiac telerehabilitation (CTR) over traditional, centre-based cardiac rehabilitation (CR).
Purpose
To evaluate the effectiveness of a novel CTR intervention on the adherence to a physically active lifestyle in patients with coronary artery disease (CAD).
Methods
We randomised patients with CAD entering phase II outpatient CR to either CTR with relapse prevention by on-demand coaching (intervention group), or centre-based CR with supervised exercise training (control group). The primary outcome measure was objectively assessed physical activity level (PAL), secondary outcome measures included physical fitness and quality of life (QoL).
Results
A total of 300 patients (89% male, mean age 60.7 ± 9.5 years) participated in the trial. Both groups significantly improved their PAL at 12 months follow-up (p < 0.01), but without a significant between-group difference in the response over time (p = 0.73). Similarly, we observed sustained increases in physical fitness and QoL, but without significant between-group differences in responses over time.
Conclusions
In patients with CAD who had low residual cardiovascular risk, CTR with relapse prevention resulted in a sustained increase in PAL, physical fitness and QoL, but without differences in responses over time as compared to centre-based CR. For this reason, future CTR interventions should be directed specifically to patients who are at risk for relapse into unhealthy lifestyle behaviour.
Main outcome measures Control (centre-based CR) Intervention (CTR) Baseline 3 months 12 months Within groups p-value 0-3 months Within groups p-value 0-12 months Baseline 3 months 12 months Within groups p-value 0-3 months Within groups p-value 0-12 months PAL † 1.40 (0.45) 1.53 (0.48) 1.55 (0.46) <0.001 0.001 1.44 (0.50) 1.67 (0.50) 1.61 (0.46) <0.001 <0.001 Workload (% of expected) * 92.1 ± 19.3 103.6 ± 19.5 104.8 ± 21.0 <0.001 <0.001 91.3 ± 18.6 101.2 ± 18.8 102.5 ± 19.6 <0.001 <0.001 KVL-H total † 5.3 (1.4) 6.1 (1.0) 6.3 (0.9) <0.001 <0.001 5.4 (1.8) 6.0 (1.0) 6.2 (1.0) <0.001 <0.001 CR cardiac rehabilitation; CTR: cardiac telerehabilitation; KVL-H: Kwaliteit van Leven bij Hartpatiënten (quality of life in cardiac patients); PAL: physical activity level. †Values reported as median (interquartile range). Within-groups differences assessed by Wilcoxon signed-rank test. *Values reported as mean ± standard deviation. Within-groups differences assessed by paired samples T-test.
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Affiliation(s)
- R Brouwers
- Maxima Medical Centre, Cardiology, Veldhoven, Netherlands (The)
| | - JJ Kraal
- Delft University of Technology (TU Delft), Department of Human-Centered Design, Faculty of Industrial Design Engineering, Delft, Netherlands (The)
| | - M Regis
- Eindhoven University of Technology, Department of Mathematics and Computer Science, Eindhoven, Netherlands (The)
| | - RF Spee
- Maxima Medical Centre, Cardiology, Veldhoven, Netherlands (The)
| | - HMC Kemps
- Eindhoven University of Technology, Department of Industrial Design, Eindhoven, Netherlands (The)
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6
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Kemps HMC, Brouwers RWM, Cramer MJ, Jorstad HT, de Kluiver EP, Kraaijenhagen RA, Kuijpers PMJC, van der Linde MR, de Melker E, Rodrigo SF, Spee RF, Sunamura M, Vromen T, Wittekoek ME. Recommendations on how to provide cardiac rehabilitation services during the COVID-19 pandemic. Neth Heart J 2020; 28:387-390. [PMID: 32676982 PMCID: PMC7364293 DOI: 10.1007/s12471-020-01474-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The ongoing coronavirus disease 2019 (COVID-19) crisis is having a large impact on acute and chronic cardiac care. Due to public health measures and the reorganisation of outpatient cardiac care, traditional centre-based cardiac rehabilitation is currently almost impossible. In addition, public health measures are having a potentially negative impact on lifestyle behaviour and general well-being. Therefore, the Working Group of Cardiovascular Prevention and Rehabilitation of the Dutch Society of Cardiology has formulated practical recommendations for the provision of cardiac rehabilitation during the COVID-19 pandemic, by using telerehabilitation programmes without face-to-face contact based on current guidelines supplemented with new insights and experiences.
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Affiliation(s)
- H M C Kemps
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands. .,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - R W M Brouwers
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - M J Cramer
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
| | - H T Jorstad
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - P M J C Kuijpers
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M R van der Linde
- Department of Cardiology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - E de Melker
- Department of Cardiology, OLVG, Amsterdam, The Netherlands
| | - S F Rodrigo
- Basalt Rehabilitation, Leiden, The Netherlands
| | - R F Spee
- Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - M Sunamura
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | - T Vromen
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
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7
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Brouwers RWM, van Exel HJ, van Hal JMC, Jorstad HT, de Kluiver EP, Kraaijenhagen RA, Kuijpers PMJC, van der Linde MR, Spee RF, Sunamura M, Uszko-Lencer NHMK, Vromen T, Wittekoek ME, Kemps HMC. Cardiac telerehabilitation as an alternative to centre-based cardiac rehabilitation. Neth Heart J 2020; 28:443-451. [PMID: 32495296 PMCID: PMC7431507 DOI: 10.1007/s12471-020-01432-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Multidisciplinary cardiac rehabilitation (CR) reduces morbidity and mortality and increases quality of life in cardiac patients. However, CR utilisation rates are low, and targets for secondary prevention of cardiovascular disease are not met in the majority of patients, indicating that secondary prevention programmes such as CR leave room for improvement. Cardiac telerehabilitation (CTR) may resolve several barriers that impede CR utilisation and sustainability of its effects. In CTR, one or more modules of CR are delivered outside the environment of the hospital or CR centre, using monitoring devices and remote communication with patients. Multidisciplinary CTR is a safe and at least equally (cost-)effective alternative to centre-based CR, and is therefore recommended in a recent addendum to the Dutch multidisciplinary CR guidelines. In this article, we describe the background and core components of this addendum on CTR, and discuss its implications for clinical practice and future perspectives.
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Affiliation(s)
- R W M Brouwers
- Flow, Centre for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Centre, Eindhoven, The Netherlands.
| | | | - J M C van Hal
- Department of Cardiology, Slingeland Hospital, Doetinchem, The Netherlands
| | - H T Jorstad
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - R A Kraaijenhagen
- NDDO Institute for Prevention and E-health Development (NIPED), Amsterdam, The Netherlands
| | - P M J C Kuijpers
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M R van der Linde
- Department of Cardiology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - R F Spee
- Flow, Centre for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Centre, Eindhoven, The Netherlands.,Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - M Sunamura
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | - N H M K Uszko-Lencer
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, The Netherlands
| | - T Vromen
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - H M C Kemps
- Flow, Centre for Prevention, Telemedicine and Rehabilitation in Chronic Disease, Máxima Medical Centre, Eindhoven, The Netherlands.,Department of Cardiology, Máxima Medical Centre, Veldhoven, The Netherlands
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8
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Vromen T, Kraal JJ, Kuiper J, Spee RF, Peek N, Kemps HM. The influence of training characteristics on the effect of aerobic exercise training in patients with chronic heart failure: A meta-regression analysis. Int J Cardiol 2016; 208:120-7. [PMID: 26849686 DOI: 10.1016/j.ijcard.2016.01.207] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/18/2016] [Accepted: 01/22/2016] [Indexed: 11/26/2022]
Abstract
Although aerobic exercise training has shown to be an effective treatment for chronic heart failure patients, there has been a debate about the design of training programs and which training characteristics are the strongest determinants of improvement in exercise capacity. Therefore, we performed a meta-regression analysis to determine a ranking of the individual effect of the training characteristics on the improvement in exercise capacity of an aerobic exercise training program in chronic heart failure patients. We focused on four training characteristics; session frequency, session duration, training intensity and program length, and their product; total energy expenditure. A systematic literature search was performed for randomized controlled trials comparing continuous aerobic exercise training with usual care. Seventeen unique articles were included in our analysis. Total energy expenditure appeared the only training characteristic with a significant effect on improvement in exercise capacity. However, the results were strongly dominated by one trial (HF-action trial), accounting for 90% of the total patient population and showing controversial results compared to other studies. A repeated analysis excluding the HF-action trial confirmed that the increase in exercise capacity is primarily determined by total energy expenditure, followed by session frequency, session duration and session intensity. These results suggest that the design of a training program requires high total energy expenditure as a main goal. Increases in training frequency and session duration appear to yield the largest improvement in exercise capacity.
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Affiliation(s)
- T Vromen
- Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Maxima Medical Center, Veldhoven, the Netherlands.
| | - J J Kraal
- Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands
| | - J Kuiper
- Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands
| | - R F Spee
- Department of Cardiology, Maxima Medical Center, Veldhoven, the Netherlands
| | - N Peek
- Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands; MRC Health eResearch Centre, University of Manchester, Manchester, United Kingdom
| | - H M Kemps
- Department of Medical Informatics, Academic Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Maxima Medical Center, Veldhoven, the Netherlands
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