Ana Helena Cavalheiro1,2, José Silva Cardoso2,3,4, Afonso Rocha2,5, Emília Moreira2,6, Luís Filipe Azevedo2,6. 1. Department of Physical Rehabilitation, Centro Hospitalar Universitário do Porto, Porto, Portugal. 2. CINTESIS, Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal. 3. Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal. 4. Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal. 5. Department of Physical Rehabilitation, Centro Hospitalar Universitário de São João, Porto, Portugal. 6. Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Portugal.
Abstract
BACKGROUND: Tele-rehabilitation (TR) may be an effective alternative or complement to centre-based cardiac rehabilitation (CBCR) with heart failure (HF) patients, helping overcome accessibility problems to CBCR. The aim of this study is to systematically review the literature in order to assess the clinical effectiveness of TR programs in the management of chronic HF patients, compared to standard of care and standard rehabilitation (CBCR). METHODS AND RESULTS: We conducted a systematic review and meta-analysis of randomized controlled trials on the effect and safety of TR programs in HF patients, regarding cardiovascular death, heart failure-related hospitalizations, functional capacity and quality of life. We searched 4 electronic databases up until May 2020, reviewed references of relevant articles and contacted experts. A quantitative synthesis of evidence was performed by means of random-effects meta-analyses. We included 17 primary studies, comprising 2206 patients. Four studies reported the number of hospitalizations (TR: 301; Control: 347). TR showed to be effective in the improvement of HF patients' functional capacity in the 6 Minute Walk-Test (Mean Difference (MD) 15.86; CI 95% [7.23; 24.49]; I2 = 74%) and in peak oxygen uptake (pVO2) results (MD 1.85; CI 95% [0.16; 3.53]; I2 = 93%). It also improved patients' quality of life (Minnesota Living with Heart Failure Questionnaire: MD -6.62; CI 95% [-11.40; -1.84]; I2 = 99%). No major adverse events were reported during TR exercise. CONCLUSION: TR showed to be superior than UC without CR on functional capacity improvement in HF patients. There is still scarce evidence of TR impact on hospitalization and cv death reduction. Further research and more standardized protocols are needed to improve evidence on TR effectiveness, safety and cost-effectiveness.
BACKGROUND: Tele-rehabilitation (TR) may be an effective alternative or complement to centre-based cardiac rehabilitation (CBCR) with heart failure (HF) patients, helping overcome accessibility problems to CBCR. The aim of this study is to systematically review the literature in order to assess the clinical effectiveness of TR programs in the management of chronic HF patients, compared to standard of care and standard rehabilitation (CBCR). METHODS AND RESULTS: We conducted a systematic review and meta-analysis of randomized controlled trials on the effect and safety of TR programs in HF patients, regarding cardiovascular death, heart failure-related hospitalizations, functional capacity and quality of life. We searched 4 electronic databases up until May 2020, reviewed references of relevant articles and contacted experts. A quantitative synthesis of evidence was performed by means of random-effects meta-analyses. We included 17 primary studies, comprising 2206 patients. Four studies reported the number of hospitalizations (TR: 301; Control: 347). TR showed to be effective in the improvement of HF patients' functional capacity in the 6 Minute Walk-Test (Mean Difference (MD) 15.86; CI 95% [7.23; 24.49]; I2 = 74%) and in peak oxygen uptake (pVO2) results (MD 1.85; CI 95% [0.16; 3.53]; I2 = 93%). It also improved patients' quality of life (Minnesota Living with Heart Failure Questionnaire: MD -6.62; CI 95% [-11.40; -1.84]; I2 = 99%). No major adverse events were reported during TR exercise. CONCLUSION: TR showed to be superior than UC without CR on functional capacity improvement in HF patients. There is still scarce evidence of TR impact on hospitalization and cv death reduction. Further research and more standardized protocols are needed to improve evidence on TR effectiveness, safety and cost-effectiveness.
Authors: Ewa Piotrowicz; Michael J Pencina; Grzegorz Opolski; Wojciech Zareba; Maciej Banach; Ilona Kowalik; Piotr Orzechowski; Dominika Szalewska; Slawomir Pluta; Renata Glówczynska; Robert Irzmanski; Artur Oreziak; Zbigniew Kalarus; Ewa Lewicka; Andrzej Cacko; Anna Mierzynska; Ryszard Piotrowicz Journal: JAMA Cardiol Date: 2020-03-01 Impact factor: 14.676
Authors: Hafiz M Imran; Muhammad Baig; Sebhat Erqou; Tracey H Taveira; Nishant R Shah; Alan Morrison; Gaurav Choudhary; Wen-Chih Wu Journal: J Am Heart Assoc Date: 2019-08-17 Impact factor: 5.501