ABSTRACT
Rationale Cardiac rehabilitation (CR) programmes are successful in educating patients and lowering their cardiovascular (CV) risk. However attendance before COVID was between 8 and 50%. Because of short duration of CR programmes sustainability in behaviour change is often suboptimal. The COVID pandemic has shown us the need for high quality remote CR. Mobile guided CR (mCR) has proven to be equally effective as centre-based CR and has the potential to increase participation rates. It also provides possibilities to extend the CR programme. Extending CR programmes with ehealth solutions have shown mixed results on sustainable behaviour change. It is still unknown what type of patients prefer mCR above regular CR when offered as standard care. REHAB+ Rehab+ is a mobile CR program, offered for one year to patients after myocardial infarction as an alternative to the regular CR program. It offers an optimised digital platform and regular interaction with the healthcare team. Patients are able to measure and register physical activity, heart frequency and intensity (BORG scale) and can monitor progress. A care professional (coach) also has access to a portal to monitor progress of different patients, advice on rehabilitation approach and stimulate compliance. Rehab+ is co-created with patients and rehab centres. In 2022, it will conclude its pilot and evaluation in 4 centres (Spain and the Netherlands), and scaled to more in the EU. Objectives: 1. To assess whether mCR programmes result in better sustained effects, as compared to the regular CR programme. 2. To explore what type of patients prefer mCR above a regular CR programme. Study population 900 Post myocardial infarction patients (300 mCR, 600 regular CR) who are indicated for CR. (See figure 1) Patients not able or willing to participate will be registered in an exclusion log. mCR patients will be coached for 12 months with decreasing amounts of touchpoints. Regular CR patients receive no coaching after the end of the regular CR program. Study design Prospective, matched control observational trial Follow-up Patients will be monitored at (see table 1): - T0: baseline characteristics, exercise test, laboratory tests, Fägerstrom test, IPAQ questionnaire, SF-36 questionnaire - T1 (3 months): Physical exam, medication, ECG, laboratory tests, adherence and compliance (mCR only),Fägerstrom test, IPAQ questionnaire, SF-36 questionnaire, eHIQ questionnaire - T2 (12 months): Physical exam, medication, ECG, laboratory tests, exercise test, adherence and compliance (mCR only),Fägerstrom test, IPAQ questionnaire, SF-36 questionnaire, eHIQ questionnaire Conclusion: Inclusion will start in November 2021. The results of this study will give insight in what type of patients choose to participate in mCR. With this information mCR programmes can be further optimised and adjusted. It may help to further increase participation rates in CR. (Table Presented).
ABSTRACT
Cardiovascular disease is the leading cause of mortality. The COVID-19 pandemic has worsened the control of risk factors and has led to an increase in heart failure and infarction mortality. There is an urgent need to optimize prevention and cardiac rehabilitation. Fortunately, we have more efficient solutions than ever before. Prescribing lifestyle and physical exercise to all cardiovascular patients. Potent lipid-lowering drugs are already well established and others will be soon, there are new aspects to improve the control of arterial hypertension, and the new era in global diabetes protection is being consolidated. Cardiac rehabilitation is much more digital and at home and the new 2021 European cardiovascular prevention guidelines insist on primary prevention and new emerging risk factors.
ABSTRACT
2020 is the year of the COVID-19 pandemic when patients with cardiovascular disease or risk factors have had the highest morbidity and mortality. This is why cardiovascular prevention and cardiac rehabilitation are more essential than ever. The treatment with cardiovascular and renal protective drugs in diabetes is unstoppable and has been updated in a new algorithm. Tobacco cessation, control of hypertension, dyslipidaemia, sedentary life and obesity are considered priorities. Also e-medicine has been implemented as never before in prevention and in order to reach the maximum number of patients, cardiac rehabilitation programs are no longer mostly face to face but online and e-supervised. The pandemic becomes an opportunity to boost prevention and cardiac rehabilitation, more necessary than ever and for everyone.