# Cardiac Telerehabilitation After Acute Coronary Syndrome Ensures Similar Improvement in Exercise Capacity as Inpatient Rehabilitation, Regardless of the Age Profile of the Compared Groups

## TL;DR

Cardiac telerehabilitation during the pandemic improved physical performance as effectively as inpatient rehab, even with age differences between groups.

## Contribution

Demonstrates that telerehabilitation provides equivalent physical improvement to inpatient rehab after heart attacks, despite older patient age in the telerehab group.

## Key findings

- Telerehabilitation patients showed similar improvement in exercise capacity as inpatient rehab patients.
- Age differences between groups did not affect the effectiveness of telerehabilitation.
- Remote monitoring of ECG, blood pressure, and body mass was feasible and effective.

## Abstract

Introduction: During the COVID-19 pandemic, the availability of cardiac rehabilitation (CR) was limited. On the other hand, during that period of epidemic restrictions, patients with acute coronary syndrome (ACS) required careful control and monitoring after coronary events. The aim of this study was to assess whether CR conducted during the epidemic restrictions in a remote mode ensured similar improvement in physical performance as CR conducted in a centre-based mode before the COVID-19 pandemic. Material and Methods: In this one-centre study, we compared the demographic and clinical profiles of patients after ACS who completed inpatient CR before the COVID-19 era with those of patients who completed telerehabilitation during the COVID-19 pandemic. We assessed the workload on the initial and final exercise tests (ExT) obtained by patients and compared the values of the differences between the final and initial ExT. The study included 359 patients (pts) participating in inpatient CR before October 2020 (the suspension of centre-based CR) and 60 pts who took part in telerehabilitation after July 2021 (the introduction of the tele-CR programme). Both inpatient and tele-CR were performed according to the guidelines of the Working Group for Cardiac Rehabilitation of the National Cardiac Society. A telemedic platform was used to control ECG, blood pressure and body mass of the pts participating in telerehabilitation. Results: The improvement of physical performance did not differ significantly between the two groups. The pts who completed telerehabilitation were significantly older than those who completed inpatient CR. The values of other parameters, such as the percentage of females, BMI, the percentage of pts with arterial hypertension and type 2 diabetes mellitus, as well as left ventricular ejection fraction did not differ significantly between the compared groups. Nor did the results of initial ExT expressed in METs, the results of final ExT and the improvement of workload understood as the difference between the final and initial results of ExT differ significantly—they were 7.7 ± 3.06 vs. 7.89 ± 2.98 with p = 0.82; 9.08 ± 0.29 vs. 8.98 ± 3.48 with p = 0.84, and 1 [0–2.2] vs. 1.2 [0–1.8] with p = 0.17, respectively. Conclusions: In our centre, telerehabilitation after acute coronary syndrome guaranteed an equally good improvement in physical capacity as that observed in inpatient CR patients, regardless of the difference in the age profile of the compared groups. These results encourage the popularization of telerehabilitation with remote monitoring of ECG, blood pressure and body mass.