P2475A randomized controlled trial of telemonitoring home-based training versus center-based in coronary heart disease: short-term results of the tele-rehabilitation in coronary heart disease (TRiCH) study

Abstract

Introduction: Cardiovascular diseases (CVD) remain the leading contributor to global mortality and morbidity. Cardiac rehabilitation (CR) is an essential part of contemporary coronary heart disease (CHD) management that aims to optimize cardiovascular risk reduction, facilitate adoption and adherence to healthy behaviors, reduce disability and promote active lifestyles. However, studies have shown that patients exiting a center‐based CR have difficulty retaining the positive effects that were derived from their weeks of participation. Therefore, there is a need for innovative rehabilitation methods focused on sustained effects on health related physical fitness. Purpose: The purpose of the TRiCH study was to compare the short and longerterm clinical effects of a home‐based (HB) CR program with telemonitoring guidance to a center‐based (CB) CR and a control group (CG) on physical fitness and other secondary outcomes in patients with coronary artery disease (CAD) in the maintenance phase (WHO Phase III). Methods: Between February 2014 and August 2016, 90 coronary artery disease patients (61.7±7.7yrs, 89% males, 1.73±0.7m, 82.8±13kg, 27.5±3.3kg/m2), who successfully completed a three month ambulatory cardiac rehabilitation program (phase II) at the hospital, were randomly allocated to one of three groups: HB (=30), CB (=30) or a Control (CG) (=30) on a 1:1:1 basis. HB patients received a telemonitoring exercise intervention, CB patients participated in the in‐hospital CR exercise program and CG patients received the standard advice on physical activity. Peak oxygen uptake (PVO2; primary outcome) and secondary outcomes (blood pressure, anthropometrics, blood lipids, glucose, quality of life, muscle strength) were assessed at baseline and after the 12 week intervention period. Results: Basic characteristics of the groups at baseline were similar. There was a drop out of 4 patients in the CG (13%), 2 in the HB group (7%). After 12 weeks of intervention, there was a significant increase in exercise capacity in the CB group of 1.3mL.kg‐1.min‐1 (95% CI ‐0.09, 2.49; P=0.034), and of 1.1mL.kg‐1.min‐1 (95% CI ‐0.04, 2.51; P=0.043) in the HB group, whereas in the CG the exercise capacity decreased 0.20mL.kg‐1.min‐1 (95% CI ‐2.01, 0.59; P=0.28). No significant differences were found for the secondary outcomes. Conclusion: After completion of a phase II program, a HB is equally effective as a CB CR program to further increase exercise capacity.