BACKGROUND:Exercise capacity is frequently reduced in patients with hypertrophic cardiomyopathy (HCM), but structured training has historically been limited due to concerns about arrhythmias and sudden cardiac death. Recent data suggest that supervised, individualized exercise may be safe in selected patients; however, evidence for hybrid cardiac telerehabilitation (HCT) in non-obstructive HCM remains lacking. AIMS:To evaluate the efficacy and safety of a 12-week HCT program in patients with non-obstructive HCM and preserved left ventricular ejection fraction. METHODS:In this single-center randomized controlled trial, 60 patients were allocated (1:1) to HCT or usual care. The HCT program consisted of supervised center-based exercise sessions combined with remotely monitored home training. The primary endpoint was the change in peak oxygen uptake (pVO₂) after 3 months. Secondary endpoints included changes in 6-minute walk distance, perceived health status, and safety parameters. Follow-up continued for 12 months after program completion. RESULTS:Fifty-eight patients completed the 3-month assessment (HCT n = 28; control n = 30). HCT resulted in a significantly greater improvement in pVO₂ compared with usual care (between-group difference: +1.35 ml/kg/min; P <0.01). Additional significant improvements were observed in 6-minute walk test distance. Perceived health status improved in both groups, with a greater increase in the HCT group. No serious adverse events occurred, and adherence to the training program was high. CONCLUSIONS:HCT is feasible, safe, and effective in improving functional capacity and perceived health status in carefully selected patients with non-obstructive HCM. These findings support the use of structured, telemonitored exercise training in low-risk HCM populations, although larger multicenter trials are needed to confirm generalizability.

Background/Objectives: Despite the known benefits of cardiac rehabilitation, it remains underutilized among women. In particular, little is known about the effectiveness of hybrid comprehensive telerehabilitation (HCTR) in women with heart failure (HF). The purpose of this study was to assess effectiveness and safety of HCTR in women with HF. Methods: This analysis formed part of the TELEREH-HF multicenter, randomized trial that enrolled 850 HF patients (NYHA I-III, LVEF ≤ 40%). Patients were randomized 1:1 to HCTR plus usual care (UC) or UC alone. Patients underwent either HCTR (1 week in hospital and 8 weeks at home, five times weekly) or UC with observation. The effectiveness of HCTR was assessed by changes in peak oxygen consumption (VO2peak), workload duration (t) in cardiopulmonary exercise test and quality of life (QoL) based on Medical Outcome Survey Short Form 36 Questionnaire (SF-36). Measurements were taken before and after intervention/observation. Results: Women constituted 11.5% of the TELEREH-HF study population. Forty women in the HCTR group and 44 women in the UC group completed program and observation, respectively. HCTR resulted in a significant improvement in VO2peak (13.4 ± 4.3 vs. 14.3 ± 4.6; 95%CI 0.91 [0.05; 1.77], p = 0.038), workload duration (301 ± 162.3 vs. 334 ± 156.6; 95%CI 33 [5; 60], p = 0.022) and SF-36 overall score (85.9 ± 13.6 vs. 89.9 ± 13.5; 95%CI 4.0 [0.6; 7.4], p = 0.024). These favorable results were not observed in the UC group VO2peak (14.2 ± 4.8 vs. 14.2 ± 4.8; 95%CI 0.02 [-1.20; 1.24], p = 0.971) and SF-36 overall score (89.1 ± 17.4 vs. 89.5 ± 15.8; 95%CI 4.0 [-2.1; 2.8], p = 0.796), except for an increase workload duration (268 ± 138.4 vs. 300 ± 130.1; 95%CI 32 [2; 62], p = 0.036). The HCTR group showed a significantly greater improvement in the physical component of QoL than the UC group. In neither group were there deaths nor major adverse events related to exercise training. Conclusions: Among women with heart failure, hybrid comprehensive telerehabilitation appears safe and leads to statistically significant although moderate improvements in physical capacity and quality of life. However, due to the small sample size, further studies in larger female populations are needed to confirm these findings.

(1) Left ventricular assist device (LVAD) implantation is increasingly used as a treatment option for patients with advanced heart failure (HF). There is a need to provide patients with LVAD with long-term care, preferably at home. The implementation of home-based telerehabilitation (HTR) and telecare offers new opportunities in this field. Purpose: The purpose of this study was to assess the feasibility and safety of HTR and telecare in HF patients with implanted LVAD and evaluate patients’ acceptance of and adherence to HTR. (2) The study enrolled 30 HF patients with recently implanted LVAD (21 Heart Mate III, 9 Heart Ware) (29 males, mean 59 years) who underwent a 12-week telecare and HTR program based on walking, respiratory, and resistance training, five times weekly. HTR was telemonitored with a device adjusted to register electrocardiogram (ECG) recordings and to transmit data via a mobile phone network to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with exercise. The influence on physical capacity was assessed by comparing changes in peak oxygen consumption (pVO2; [mL/kg/min]) and workload duration (t; [s]) during the cardiopulmonary exercise test. (3) HTR resulted in a significant physical capacity improvement in pVO2 12.5 ± 2.9 vs. 15.1 ± 3.0 (p < 0.001), and workload duration t 628 ± 204 vs. 728 ± 222 (p < 0.001) during the cardiopulmonary exercise test. There were neither deaths nor adverse events during HTR. Patients accepted HTR, including the need for interactive everyday collaboration with the medical team. All patients completed HTR. (4) HTR is a feasible and safe form of rehabilitation that is well-accepted by patients. The adherence to HTCR was high.

During qualification for mechanical circulatory support, the comprehensive assessment of a patient's mental state is an integral element of the overall medical evaluation. It encompasses a range of psychosocial issues, and as such provides information helpful in the selection of a suitable candidate for the required treatment, and sometimes identifies contraindications to it. It allows ensuring that the patient meets expectations regarding both mental health stability and adherence to medical recommendations. It is also helpful in an early detection and diagnosis of mental problems before the surgery, which can increase the possibility of implementation of appropriate treatment and intervention. Due to the lack of generally accepted guidelines, this assessment can be subjective to some extent, especially if it takes place outside experi-enced transplant centres. This article presents the core principles of mental status evaluation and management of candidates for heart transplantation or mechanical circulatory support, and psychosocial factors increasing the risk of poor prognosis in this group. The article aims to share with psychiatrists and psychologists the clinical experience and comprehensive knowledge about psychosocial eligibility criteria for mechanical circulatory support or heart transplantation.

Abstract Background Managed Care after Acute Myocardial Infarction (MC-AMI) is a one-year comprehensive care program dedicated to patients with acute coronary syndrome introduced in Poland. It includes acute intervention, complex revascularization, implantation of cardiovascular electronic devices (in case of indications), rehabilitation or hybrid rehabilitation (HTR) and scheduled outpatient follow-up. HTR is a unique component of MC-AMI program. Purpose The purpose of this study was to evaluate whether the effect of improving physical capacity achieved after 5-week HTR was maintained during one-year follow-up. Methods The study enrolled 84 patients (90% males, aged 57.5 ± 10.2 years, LVEF 54,6 ± 6.8%) who underwent a 5-week HTR based on Nordic walking training and completed the entire one-year MC-AMI program. Unless there were contraindications, HTR began no later than 14 days after discharge from the hospital and consisted of an initial phase (1 week) conducted in an outpatient center and 4 weeks of telemonitored exercise training at home, five times weekly. Exercise capacity was assessed by comparing the exercise test results at baseline (before HTR), immediately after HTR and at the end of one-year MC-AMI program. Results HTR resulted in significant improvement in workload [METS] and workload duration in exercise test. This valuable effects were maintained after one-year follow-up. All results are presented in Table 1 and Figure 1. Conclusion The improvement in physical capacity achieved after 5-week of the hybrid telerehabilitation was maintained in patients who completed MC-AMI program in one-year follow-up.

Treatment of patients with advanced heart failure (HF) with the use of left ventricular assist devices (LVADs) improves the quality of life and the length of survival. Despite the undeniable benefits associated with improved physical performance, as a result of the decrease of the underlying disease symptoms, it carries the risk of complications in the area of the patient's somatic and psychological status. Long-term circulatory failure can contribute to a weakening of the adaptative mechanism and consequently lead to a variety of emotional disruptions. Patients must face the fear of imminent physical, family, and social changes that in the early postoperative period also disorders of consciousness with a pattern of delirium. For this reason, it is advisable to provide multidisciplinary medical care for the patient at all stages of treatment, including regular monitoring of general health and mental health. This article presents risk factors for psychiatric disorders in patients with LVADs and ways of pharmacological and non-pharmacological management when these factors are identified and disorders are diagnosed.

Abstract Purpose Hypertrophic cardiomyopathy (HCM) is a complex cardiac disorder, that influences patients' physical capacity and quality of life, as well as the risk of sudden cardiac death (SCD). Patients with HCM often experience emotional distress due to the uncertainty of their condition and have a threatening illness perception (the way individuals make sense of their illness, which can have a significant impact on adherence to treatment). Current studies suggest that some HCM patients could benefit from hybrid cardiac telerehabilitation (HCTR) in terms of somatic and psychological status. This study is part of a research project investigating the safety and effectiveness of hybrid cardiac telerehabilitation for HCM patients. The specific focus of this part is to evaluate the changes in mental health status and illness perception of HCM patients who have been referred for cardiac telerehabilitation compared to those receiving usual care. Methods An RCT study was conducted, with the inclusion criteria for the study of being above 18 y.o., HCM without LVOT obstruction, NYHA Class II or III, LVEF ≥ 50%, and having CIED. The study involved telerehabilitation (HCTR) and control (CG) groups. Both groups were completing questionnaires assessing illness perception (Brief IPQ) and overall psychosocial distress (GHQ-28) with its 4 domains: somatic symptoms, anxiety, social impairment, and depression. Psychological assessment was performed at the beginning and at the end of telerehabilitation/outpatient care, and at 3, 6 and 12 months after the end of care (T1/T2/T3/T4/T5). Results There was a significant improvement in the overall distress level in the HCTR group (p=0.003) but not in the CG (p=0.559). It remained significant in the HCTR group for the T2 (p<0.001), T3 (p=0.008), and T4 (p<0.001). The positive change was observed in somatic symptoms only in the HCTR group: for T2 (p=0.025) and T3 (p=0.032) compared to the T1. The gradual decrease in anxiety level was observed in the HCTR group, but not in the CG, with a significant difference for T4 (p=0.013) compared to T1. Although there was an improvement in social impairment in both groups (p=0.049 for the CG, and p=0<0.001 for the HCTR group), only in the HCTR group it held a stable pattern after the intervention (p<0.001 for T2; p=0.013 for T3; p=0.032 for T4). There were no changes in the level of depressive symptoms in either of the compared groups. There were also no significant differences in the illness perception (p=0.200 for the HCTR group and p=0.090 for the CG), although the HCTR group showed short-term improvement after three months of HCTR (T2) (p=0.032). Conclusions There are significant benefits of hybrid cardiac telerehabilitation for mental health, level of distress, and illness perception in HCM patients. It is worth noticing that this improvement is short-term, and prolonged effects might require providing additional support during extended care.overall distress in HCTR vs CGsubscales of GHQ_28 in HCTR vs CG

Abstract Background Left ventricular assist device (LVAD) implantation is increasingly used as a treatment option for patients with advanced heart failure (HF). There is a need to provide patients with LVAD with long-term care, preferably at home. The implementation of home-based telerehabilitation (HTR) and telecare offers new opportunities in this field. Purpose The purpose of this study was to assess feasibility and safety of HTR and telecare in HF patients with implanted LVAD and evaluate patients’ acceptance of and adherene to HTR. Methods The study enrolled 30 HF patients with recent implanted LVAD (21 Heart Mate III, 9 Heart Ware) (29 males, 19–67, mean 59 years) who underwent a 12-week telecare and HTR program based on walking, respiratory and resistance training, five times weekly. HTR was telemonitored with a device adjusted to register electrocardiogram (ECG) recording and to transmit data via mobile phone network to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with exercise. The influence on physical capacity was assessed by comparing changes in peak oxygen consumption (VO2 peak; [ml/kg/min]) and workload duration (t; [sec]) in cardiopulmonary exercise test. Results HTR resulted in a significant physical capacity improvement pVO2 12.5±2.9 vs 15.1±3.0 (p<0.001), and workload duration t 628±204 vs 728±222 (p<0.001) in cardiopulmonary exercise test. There were neither deaths nor adverse events during HTR. Patients accepted HTR, including the need for interactive everyday collaboration with the medical team from monitoring center. All patients completed HTR. Conclusions HTR is a feasible, safe form of rehabilitation, well accepted by patients. The adherence to HTCR was high.

Journal Article Accepted manuscript eHealth for maintenance cardiovascular rehabilitation – current status and future challenges Get access Ewa Piotrowicz, MD, PhD, FESC Ewa Piotrowicz, MD, PhD, FESC Telecardiology Center, National Institute of Cardiology, Warsaw, Poland Corresponding Author Email: epiotrowicz@ikard.pl https://orcid.org/0000-0002-7302-237X Search for other works by this author on: Oxford Academic Google Scholar European Journal of Preventive Cardiology, zwad195, https://doi.org/10.1093/eurjpc/zwad195 Published: 14 June 2023 Article history Received: 05 June 2023 Accepted: 07 June 2023 Published: 14 June 2023

AIMS:Current European heart failure (HF) guidelines suggest the use of risk score: among them, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score has demonstrated to be one of the most accurate. However, the risk scores are still poorly implemented in clinical practice, also due to the lack of strong evidence regarding their external validation in different populations. Thus, the current study was designed as an external validation test of the MECKI score in an international multicentre setting. METHODS AND RESULTS:The study cohort consisted of patients diagnosed with HF with reduced ejection fraction (HFrEF) across international centres (not Italian), retrospectively recruited. Collected data included demographics, HF aetiology, laboratory testing, electrocardiogram (ECG), echocardiographic findings, and cardiopulmonary exercise testing (CPET) results as described in the original MECKI score publication. A total of 1042 patients across 8 international centres (7 European and 1 Asian) were included and followed up from 1998 till 2019. Patients were divided according to the calculated MECKI scores into three subgroups: (i) MECKI score <10%, (ii) 10-20%, and (iii) ≥ 20%. Survival analysis comparison among the three MECKI score subgroups showed a worse prognosis in patients with higher MECKI score value: median event-free survival times were 4396 days for MECKI score <10%, 3457 days for 10-20%, and 1022 days for ≥20% (P < 0.0001). Receiver operating characteristic (ROC) curves and area under the ROC curves (AUC) were like those reported in the original internal validation studies. CONCLUSION:In patients diagnosed with HFrEF, the power of the MECKI score was confirmed in terms of prognosis and risk stratification, supporting its implementation as advised by the HF guidelines.

INTRODUCTION Managed Care after Myocardial Infarction (MC -AMI [KOS-Zawal]), a comprehensive care program dedicated to patients after myocardial infarction, was implemented in Poland in 2017. Hybrid cardiac telerehabilitation (HTR) is a unique component of MC -AMI.OBJECTIVES We evaluated the feasibility of HTR as a component of MC -AMI and assessed its safety and acceptance by patients. One -year all -cause mortality among the patients participating and not participating in MC -AMI was analyzed.PATIENTS AND METHODS The MC -AMI group included 114 patients who underwent a 5 -week HTR program comprising telemonitored Nordic walking training sessions, and who completed the entire 12 -month MC -AMI program. The influence of HTR on the physical capacity was assessed by comparing the stress test results before and after HTR. After HTR, the patients completed a satisfaction survey to assess their acceptance of the program. The non-MC -AMI group was formed using propensity score matching to compare 1 -year all -cause mortality between the patients participating and not participating in MC-AMI.RESULTS HTR significantly improved the functional capacity assessed in the stress test and was well--receivedby the patients. In the study group, nonfatal non-ST -segment elevation myocardial infarction, elective coronary percutaneous intervention, and cardiovascular hospitalization occurred in 0.9%, 2.6% and 6.1% of the patients, respectively. There were no deaths among the MC -AMI participants, whereas in the non-MC -AMI group, 1 -year all -cause mortality was 3.5%. The log -rank test comparing the sur-vival probabilities of matched groups, estimated by the Kaplan-Meier method, showed heterogeneity of the curves (P = 0.04).CONCLUSIONS HTR as a component of MC -AMI was a feasible, safe, and well -accepted form of cardiac rehabilitation. Participation in MC -AMI including HTR was associated with a significantly lower risk of 1 -year all -cause mortality, as compared with not taking part in the rehabilitation program.

Background: Assessing prognosis in heart failure (HF) is of major importance. Aims: The study aimed to define predictors influencing long-term cardiovascular mortality or HF hospitalization ("composite outcome") based on clinical status and measurements obtained after a 9-week hybrid comprehensive telerehabilitation (HCTR) program.Methods: This analysis is based on the TELEREH-HF (TELEREHabilitation in Heart Failure) multicenter randomized trial that enrolled 850 HF patients (left ventricular ejection fraction [LVEF] & LE;40%). Patients were randomized 1:1 to 9-week HCTR plus usual care (experimental arm) or usual care only (control arm) and followed for median (interquartile range [IQR]) 24 (20-24) months for development of the composite outcome.Results: Over 12-24 months of follow-up, 108 (28.1%) patients experienced the composite outcome. The predictors of our composite outcome were: nonischemic etiology of HF, diabetes, higher serum level of N-terminal prohormone of brain natriuretic peptide, creatinine, and high-sensitivity C -re-active protein; low carbon dioxide output at peak exercise; high minute ventilation and breathing frequency at maximum effort in cardiopulmonary exercise tests; increase in delta of average heart rate in 24-hour Holter ECG monitoring, lower LVEF, and patients' non-adherence to HCTR. The model discrimination C-index was 0.795 and decreased to 0.755 on validation conducted in the control sample which was not used in derivation. The 2-year risk of the composite outcome was 48% in the top tertile versus 5% in the bottom tertile of the developed risk score.Conclusion: Risk factors collected at the end of the 9-week telerehabilitation period performed well in stratifying patients based on their 2-year risk of the composite outcome. Patients in the top tertile had an almost ten-fold higher risk compared to patients in the bottom tertile. Treatment adherence, but not peak VO2 or quality of life, was significantly associated with the outcome.

Despite advances in the treatment of heart failure (HF), the rate of hospitalisation for exacerbations of the disease remains high. One of the underlying reasons is that recommended guidelines for the management of HF are still too rarely followed in daily practice. Disease exacerbation requiring inpatient treatment is always afactor that worsens the prognosis, and thus signals disease progression. This is also akey moment when therapy should be modified for HF exacerbation, or initiated in the case of newly diagnosed disease. Inpatient treatment and the peri‑discharge period is the time when the aetiology and mechanism of HF decompensation should be established. Therapy should be individualised based on aetiology, HF phenotype, and comorbidities; it should take into account the possibilities of modern treatment. According to the recommendations of the European Society of Cardiology (ESC), patients with HF should receive multidisciplinary management. Cooperation between the various members of the multidisciplinary team taking care of patients with HF improves the efficiency and quality of treatment. This document expands and details the information on the peri‑discharge management of HF contained in the 2021 ESC guidelines and the 2022 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Failure Society of America (HFSA) guidelines.

Telerehabilitation (TR) was developed to achieve the same results as would be achieved by the standard rehabilitation process and to overcome potential geographical barriers and staff deficiencies. This is especially relevant in periodic crisis situations, including the recent COVID-19 pandemic. Proper execution of TR strategy requires both well-educated staff and dedicated equipment. Various studies have shown that TR may have similar effects to traditional rehabilitation in terms of clinical outcomes and may also reduce total healthcare costs per participant, including rehospitalization costs. However, as with any method, TR has its advantages and disadvantages, including a lack of direct contact or prerequisite, rudimentary ability of the patients to handle mobile devices, among other competencies. Herein, is a discussion of the current status of TR, focusing primarily on cardiac TR, describing some technical/organizational and legal aspects, highlighting the indications, examining cost-effectiveness, as well as outlining possible future directions.

Telerehabilitation for heart failure (HF) patients is beneficial for physical functioning, prognosis, and psychological status. The study aimed at evaluating the influence of hybrid comprehensive telerehabilitation (HCTR) on the level of anxiety in comparison to usual care (UC). The TELEREH-HF study was a multicenter prospective RCT in 850 clinically stable HF participants. Patients underwent clinical examinations, including the assessment of anxiety, at entry and after the 9-week training program (HCTR) or observation (UC). The State-Trait Anxiety Inventory (STAI) was used. 20.3