Cardiac telerehabilitation: current situation and future challenges.

Coronary heart disease is a leading cause of death globally. Cardiac rehabilitation (CR) programs reduce recurrent events, improve risk factors and enhance quality of life through physical activity and education. However, only one-third of eligible patients attend a CR program. Availability of such programs is limited particular in areas with low levels of development and low population density. Therefore, innovative models for secondary prevention are necessary to increase access by adaption of such programs to the diversity of people and communities. Monitoring cardiovascular risk factors seems to be particularly appropriate for the use of telemedicine. This includes health applications to improve lifestyle by surveillance, education, psychological support and interactive motivational tools with the final goal of reducing metabolic risk factors and reducing cardiovascular morbidity and mortality. So far, telemedical studies have mostly investigated electrocardiogram (ECG)-monitored exercise training at home and internet-based counseling for lifestyle modification in selected low-risk patients after an acute cardiac event. First reports of telerehabilitation in patients with heart failure are also promising. However, we need large scale prospective randomized studies to show that cardiac telerehabilitation is equally effective as it has been shown for exercise-based outpatient CR programs which are provided according to current standards and guidelines. Cardiac telerehabilitation is a promising new tool in particular to include patients in CR which are not living near a center-based CR program or who are not able to attend such a program for various reasons and to improve long-term adherence to a healthy lifestyle after center-based CR.