Authors (including presenting author) :
Chan NY(1), Lam SK(1), Chiu SH(1), Chan WMM(2), Wong CYJ(3), Leung YYC(4), Ng WBG(5), Wong WK(6), Chu LL(7)
Affiliation :
(1) Department of Medicine & Geriatrics, Princess Margaret Hospital
(2) Community Health Care, Kowloon West Cluster
(3) Occupational Therapy Department, Princess Margaret Hospital
(4) Physiotherapy Department, Princess Margaret Hospital
(5) Dietetics Department, Kowloon West Cluster
(6) Department of Medicine, Yan Chai Hospital
(7) Department of Medicine & Geriatrics, Caritas Medical Centre
Introduction :
Cardiac rehabilitation is cost-effective and reduces mortality in patients with cardiovascular diseases. However, the uptake rate is commonly below 20%. Home-based tele-cardiac rehabilitation (TeleCR) would enhance uptake rate. Nevertheless, data on its effectiveness and safety is lacking.
Objectives :
To pilot a TeleCR program in Princess Margaret Hospital and study its effectiveness and safety in patients with low-risk cardiovascular diseases.
Methodology :
A first-in-Hong Kong TeleCR program was designed and has been implemented since October 2020. The program lasted 12 weeks and patients physically attended the Physiotherapy Department before and after the program. Before the program, patients were taught on the use of home exercise and heart health videos. 6 phone consultations with physiotherapist on exercise prescription, review and compliance; and 5 phone consultations with a multidisciplinary team on heart health knowledge assessment were scheduled during the 12-week program. Anthropometric measurements, biochemical tests, exercise tolerance, exercise efficacy and psychological status were evaluated before and after the program. Outcomes of TeleCR were compared with centre-based cardiac rehabilitation program (CenCR).
Result & Outcome :
81 patients (75 men, mean age 57.3±9.4) participating in TeleCR were compared with 66 patients undergoing CenCR. After TeleCR, patients had significant reduction in waist circumference (92.8±9.2 vs 90.2±10.4cm, p=0.0002), total cholesterol (4.1±1.3 vs 3.2±0.6mmol/L, p<0.0001), LDL-cholesterol (2.3±1.2 vs 1.4±0.5mmol/L, p<0.0001) and anxiety domain of Depression Anxiety and Stress Scale (DASS) (3.6±3.5 vs 2.1±2.9, p=0.002). Significant improvement was observed in 6-minute walk distance (6MWT) (482.5±74.2 vs 517.9±83.9m, p<0.0001), cardiac exercise self-efficacy instrument score (CESEI) (62.7±10.5 vs 67.7±9.8, p=0.002) and proportion of patients with Grade 1 Specific Activity Scale (SAS) (75.3 vs 92%, p=0.0079). Compared with CenCR group, the magnitude of improvement was similar in waist circumference (2.8±5.4 vs 2.3±4.5%, p=0.568), total cholesterol (17±23.5 vs 12.7±24%, p=0.448), LDL-cholesterol (23.9±33.7 vs 8.4±48.3%, p=0.147), anxiety domain of DASS (1.6±3.7 vs 1.0±3.4 points reduction, p=0.317), 6MWT (10.8±14.6 vs 13±10.9%, p=0.333) and Grade 1 SAS proportion (17.2 vs 19%, p=0.782). The magnitude of improvement in CESEI was significantly higher in CenCR than TeleCR groups (22.6±30.4 vs 12±26.5, p=0.039). No adverse incident was observed in TeleCR group. Our study has shown that TeleCR is safe and effective for patients with low-risk cardiovascular diseases and the outcomes are highly comparable to those of CenCR.
