BackgroundMost studies failed to show superiority of cardiac telerehabilitation (CTR) over traditional, centre-based cardiac rehabilitation (CR).PurposeTo evaluate the effectiveness of a novel CTR intervention on the adherence to a physically active lifestyle in patients with coronary artery disease (CAD).MethodsWe 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).ResultsA 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.ConclusionsIn 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.@en

Background: Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) often coexist and are associated with a high morbidity and reduced quality of life (QoL). Although these diseases share similarities in symptoms and clinical course, and exacerbations of both diseases often overlap, care pathways for both conditions are usually not integrated. This results in frequent outpatient consultations and suboptimal treatment during exacerbations, leading to frequent hospital admissions. Therefore, we propose an integrated care pathway for both diseases, using telemonitoring to detect deterioration at an early stage and a single case manager for both diseases.

Objective: This study aims to investigate whether an integrated care pathway using telemonitoring in patients with combined CHF and COPD results in a higher general health-related QoL (HRQoL) as compared with the traditional care pathways. Secondary end points include disease-specific HRQoL, level of self-management, patient satisfaction, compliance to the program, and cost-effectiveness.

Methods: This is a monocenter, prospective study using a quasi-experimental interrupted time series design. Thirty patients with combined CHF and COPD are included. The study period of 2.5 years per patient is divided into a preintervention phase (6 months) and a postintervention phase (2 years) in which end points are assessed. The intervention consists of an on-demand treatment strategy based on monitoring symptoms related to CHF/COPD and vital parameters (weight, blood pressure, heart rate, oxygen saturation, temperature), which are uploaded on a digital platform. The monitoring frequency and the limit values of the measurements to detect abnormalities are determined individually. Monitoring is performed by a case manager, who has the opportunity for a daily multidisciplinary meeting with both the cardiologist and the pulmonologist. Routine appointments at the outpatient clinic are cancelled and replaced by telemonitoring-guided treatment.

Results: Following ethical approval of the study protocol, the first patient was included in May 2018. Inclusion is expected to be complete in May 2021.

Conclusions: This study is the first to evaluate the effects of a novel integrated care pathway using telemonitoring for patients with combined CHF and COPD. Unique to this study is the concept of remote on-demand disease management by a single case manager for both diseases, combined with multidisciplinary meetings. Moreover, modern telemonitoring technology is used instead of, rather than as an addition to, regular care.

Trial Registration: Netherlands Trial Register NL6741; https://www.trialregister.nl/trial/6741

International Registered Report Identifier (IRRID): DERR1-10.2196/20571@en