Cardio4Health study. A cardiac telerehabilitation program aimed at patients after an ischemic event: evaluation of its effectiveness and safety (Preprint)

BACKGROUND Center-based cardiac rehabilitation programs (CRPs) reduce morbidity and mortality after an ischemic cardiac event; however, they are widely underutilized. Home-based CRP has emerged as an alternative to improve patient adherence; however, its safety and efficacy remain unclear, especially for older patients and women. OBJECTIVE To develop a holistic home-based CRP for patients with the ischemic heart disease and evaluate its safety and impact on functional capacity, adherence to a healthy lifestyle, and quality of life. METHODS The 8-week home-based CRP included patients of both sexes with no age limit who had suffered an acute myocardial infarction in the previous three months, with left ventricular ejection fraction (LVEF) ≥40% and had access to a tablet/mobile device. The CRP was developed using a dedicated platform specifically designed for this purpose and included thrice weekly exercise sessions combining tailored aerobic and strength training and once weekly educational sessions focused on lifestyle habits, therapeutic adherence, and patient empowerment. RESULTS We initially included 62 patients, of whom one was excluded for presenting with ventricular arrhythmias during the initial stress test and five due to incompatibility and six dropped out due to a technological barrier. Ultimately, 50 patients completed the program. The CRP significantly improved the functional capacity, muscle strength, weekly training volume, adherence to the Mediterranean diet, emotional state (anxiety), and quality of life. No major complications occurred, and adherence was excellent (>80%) for both the exercise and educational sessions. In the subgroup analysis, CRP showed equivalent beneficial effects irrespective of sex and age. Additionally, patient preferences for CRP approaches were equally distributed, with one-third of the patients preferring a face-to-face CRP, one-third a telematic, and one-third a hybrid approach. CONCLUSIONS A holistic telematic CRP dedicated to patients after an ischemic cardiac event, irrespective of sex and age, is safe and effective in improving the maximal aerobic capacity, weekly training volume, muscle strength, quality of life, compliance with diet, and anxiety symptoms. The preference for a center- or home-based CRP approach is diverse among the study population, emphasizing the need for a tailored CRP to improve adherence and completion rates.