CARDIAC REHABILITATION USING REMOTE TECHNOLOGIES FOR PATIENTS AFTER CORONARY ARTERY BYPASS GRAFTING: EVALUATION OF SAFETY AND EFFICACY

Highlights

The study evaluates the safety and efficacy of an outpatient cardiac rehabilitation (CR) program using remote technologies compared to a traditional physician-supervised in-person CR program in patients after coronary artery bypass grafting (CABG). It was shown that the remote format is non-inferior to in-person rehabilitation in terms of safety and efficacy and demonstrates advantages in several parameters, such as adherence to physical training (PT) and the maintenance of achieved exercise tolerance (ET) levels.

Aim. To evaluate the safety and efficacy of an outpatient CR program using remote monitoring technologies compared to a traditional CR program in a rehabilitation center for patients after CABG.

Methods. The study included 108 patients who had undergone elective CABG. After completing the inpatient phases of CR, patients were randomized into two groups. Group 1 (n = 51) received standard center-based CR with bicycle ergometer training under direct physician supervision. Group 2 (n = 57) underwent a home-based CR program with independent PT, using remote monitoring tools (a pedometer and the domestic “Nomokard” 4-lead Holter ECG monitor). The duration of the PT phase was three months for both groups. Key endpoints were ET, adherence to PT and pharmacotherapy, achievement of target risk factor levels (BP, HR, LDL-C, smoking cessation), and the frequency of adverse events during 12 months of follow-up.

Results. After 3 months of PT, both groups showed a significant and comparable increase in ET. However, after 12 months of follow-up, the home-based training group with remote ECG monitoring maintained a statistically significant improvement in ET (from 104 W to 107.5 W; p = 0.003), while the clinic-based training group showed a decrease from the peak value (from 112 W to 105 W; p = 0.024). The proportion of highly adherent patients was higher in the home-based training group (52.6% vs. 37.3%). No significant differences in the frequency of serious adverse events (death, myocardial infarction (MI), acute cerebrovascular accident (stroke), hospitalization due to CAD progression) were found between the groups. After one year, both groups recorded significant and comparable improvements in medication adherence, achievement of target BP and HR levels, and smoking cessation. Remote ECG monitoring in the home-based training group allowed for the timely detection and management of significant arrhythmias (e.g., transient AV block, atrial fibrillation) without interrupting the rehabilitation process.

Conclusion. A home-based CR program with remote ECG monitoring and telephone support is non-inferior to traditional clinic-based CR in terms of safety and efficacy for patients after CABG. Furthermore, it demonstrates advantages regarding the long-term maintenance of functional achievements and adherence to PT. The use of remote technologies enhances patient engagement and allows for the prompt diagnosis and management of potential complications in an outpatient setting.

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