Remote Cardiac Rehabilitation in Older Cardiac Disease: A Randomized Case Series Feasibility Study

Background: Cardiac rehabilitation (CR) in the long term is fundamental to achieve better outcomes. However, most patients may find it difficult to maintain healthy lifestyle behavior after ambulatory CR program. We aimed to investigate the feasibility on remote CR support program (Remote-CR) in older patients with cardiac disease. Methods: Between October 2020 and February 2021, we enrolled older patients with cardiac disease after at least over 5 months of ambulatory CR program. The study was conducted as a randomized controlled case series to compare Remote-CR vs. center-based CR (CB-CR) after ambulatory CR in older patients with cardiac disease. The core component of Remote-CR is a web application, which evaluates vital sign and receives feedback through real-time video consultation once a week. We evaluated the satisfaction of Remote-CR, and impact of Remote-CR on adherence to exercise and physical activity management. Moreover, we assessed the change in functional status using handgrip strength, usual gait speed, short physical performance battery (SPPB), and Kihon checklist (KCL) before the intervention, at the end of the 4-week intervention, and cardiovascular-related hospital discharge within 6 months after completion of ambulatory CR. Results: Eleven patients were enrolled (six for Remote-CR and five for CB-CR). All participants completed the intervention without serious adverse event in each group. After the on-site initial remote system set up, all the patients completed the Remote-CR session without on-site assistance. Patients' satisfaction with Remote-CR was generally high. Remote-CR helps to maintain healthy lifestyle behavior. In addition, Remote-CR and CB-CR seem to be equally successful in maintaining functional status and preventing cardiovascular-related hospital readmission. Conclusions: This trial suggested the Remote-CR comprising a hybrid of information and communication technology and strategy for health behavior change may be a feasible and safe intervention option in selected older patients with cardiac disease after completion of ambulatory CR.