Hybrid telerehabilitation in patients with hypertrophic cardiomyopathy without left ventricular outflow tract obstruction and preserved left ventricular ejection fraction-the randomised clinical trial

Background

Hypertrophic cardiomyopathy (HCM) is the most common hereditary heart disease, and its diagnosis is often associated with limited physical activity. Little is known about cardiac rehabilitation programs for patients with HCM. Therefore the novel hybrid cardiac telerehabilitation (HCTR) model consisting of hospital-based rehabilitation and home-based telemonitored rehabilitation might be an option to improve physical capacity in patients with HCM.

Purpose

To evaluate the safety, effectiveness and adherence to HCTR in patients with HCM without the left ventricle (LV) outflow tract obstruction and preserved LV ejection fraction.

Methods

The study group comprised 60 patients with HCM (51.1±13.3 years; NYHA II-III; LV ejection fraction 66.1±6.9%). Patients were randomised (1:1) to either HCTR program (hospital-based rehabilitation [1 month] based on cycloergometer training and home-based telemonitored rehabilitation [2 months] based on Nordic walking, five times a week, at 40–70% of maximal estimated heart rate) - training group (TG), or to a control group (CG). All patients had implantable cardioverter-defibrillator. In order to perform home-based telemonitored rehabilitation, a special device was used which enabled patients to: (1) do Nordic walking training according to a preprogrammed plan, (2) record and send electrocardiograms (ECGs) via mobile phone network to the monitoring centre. The moments of automatic ECGs registration were pre-set and coordinated with exercise training. The effectiveness of HCTR was assessed by changes - delta (Δ) in duration (t) of the workload, peak oxygen consumption (pVO2) in cardiopulmonary exercise test, 6-minute walking test distance (6-MWT) as a result of comparing t (s), pVO2 (ml/kg/min), 6-MWT (m) from the beginning and the end of the program.

Results

Safety of HCTR. Neither death nor other serious adverse events occurred during HCTR. We did not observe any ICDs intervention during the HCTR.

Effectiveness of HCTR: Within-group analysis: t, pVO2, 6-MWT increased significantly in TG: t 657±183 vs 766±181 (p<0.001), pVO2 19.2±5.0 vs 20.6±4.9 (p=0.007), 6-MWT 445±88 vs 551±77 (p<0.001). In the untrained CG, the unfavourable results were observed: 695±198 vs 717±187 (p=0.114), pVO2 21.2±5.1 vs 21.1±5.6 (p=0.723), 6-MWT 512±83 vs 536±84 (p=0.061).

Between-group analysis: The differences between TG and CG were statistically significant: in Δt (p<0.001); ΔpVO2 (p=0.012); Δ6-MWT (p<0.001).

Adherence to HCTR: In TG 28 patients (93%) completed the HCTR program. Two patients did no undergo HCTR because of personal issues.

Conclusion

Hybrid cardiac telerehabilitation in patients with HCM without the left ventricle (LV) outflow tract obstruction and preserved LV ejection fraction is safe and effective. The adherence to HCTR is high.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Statutory work in The Cardinal Stefan Wyszyński National Institute of Cardiology in Warsaw, Poland

Illness experience and adjustment to treatment in hypertrophic cardiomyopathy patients undergoing cardiac rehabilitation: qualitative study

Funding Acknowledgements

Study No. 2.1/I/17, Sadowski, K. MD

Background. Hypertrophic cardiomyopathy (HCM) is an hereditary disease in which the heart muscle becomes abnormally thick, which makes it harder for the heart to pump blood. Some people with HCM experience medical complications, including heart failure or sudden cardiac death (SCD). Due to lack of efficient causal treatment, the goal of HCM treatment is to relieve symptoms, slow down disease development and prevent SCD. For many years one of the major lifestyle recommendations for HCM patients was to refrain from excessive physical activity and stressful situations. At the same time, there is multiple scientific evidence that cardiac rehabilitation and regular physical activity can be beneficial in terms of treatment outcome and survival in cardiac patients. Nevertheless, data on adjustment and physical activity among HCM patients are scarce.

Purpose. The presented study is a part of research on the effectiveness and safety of cardiac rehabilitation in HCM patients. This part aims to assess illness perception and adjustment to treatment among patients with HCM.

Method. The study is an experimental randomized control trial (RCT). In part related to adjustment and mental health there are quantitative and qualitative measures used: questionnaires related to general health, illness perception, level of stress, adherence to treatment, and semi-structured interviews performed to assess patients’ concerns regarding illness identity, the impact of HCM on everyday life, and expectations of themselves and the medical team. The entire study population consists of 60 participants with HCM (cardiac rehabilitation/telerehabilitation vs usual care). Quantitative data will be analysed using appropriate tests (e.g. t-Student, regression analysis) and qualitative data will be analysed using Interpretative Phenomenological Analysis.

Results. Preliminary results evaluate adjustment to treatment based on patients" experience and illness perception. The group for the qualitative study consists of 20 participants (M = 51,70; SD = 11,07; 13 F/ 5 M). Starting the treatment often led to intense distress because 70% of them have been diagnosed accidentally (20% after diagnosis or death of a family member). 20% of participants describe HCM using negative terms, and patients’ identity of HCM fall along a continuum from "curse"/"nightmare" to "value"/"relief". Patients’ adjustment is influenced the most by "being a role model for relatives struggling with HCM" and „adapting to barriers", and the most important expectation toward medical professionals was to be "approachable" and „attentive", which strenghtened the sense of security in threatening medical situations.

Conclusions. Although many patients identify HCM as a burden, their adjustment to illness is mostly related to their need for being a positive role model for relatives with HCM. A therapeutic alliance with the medical team and experiencing kindness were the most important for the sense of security and being well treated.

The Partisan Impact on Local Government Dissemination of COVID-19 Information: Assessing US County Government Websites

This study explores the relationship between local government dissemination of COVID-19 information and partisanship. The unit of analysis is all official county government websites in the United States. In particular, we investigate if there is a correlation between the overall partisanship of a county and whether a county government's website (1) mentions COVID-19 and (2) provides safety instructions concerning COVID-19. We hypothesize that mass partisanship will impact the probability that a county government's website provides information related to the coronavirus. We find that a larger share of Democratic voters in a county is associated with an increase in the probability that a county government's website mentions COVID-19 and provides safety instructions for its residents. The results hold even after controlling for population density, internet subscriptions and COVID-19 cases and deaths. The finding indicates that citizens’ access to information, even on matters of public health, are partially a consequence of partisanship.