Long-term Effects of 3-Month Home-Based Cardiac Rehabilitation Using Information and Communication Technology for Heart Failure with Physical Frailty

TL;DR

This study found that a 3-month home-based cardiac rehab program using technology improved heart failure patients' walking ability and frailty, but these benefits faded over 12 months without ongoing professional support.

Contribution

The study is one of the first to evaluate long-term outcomes of ICT-based home cardiac rehab in heart failure patients with physical frailty.

Findings

6-minute walking distance improved significantly at 3 months but declined by 15 months.

Frailty scores decreased at 3 months but worsened by 15 months.

Patients who continued exercising maintained walking improvements at 15 months.

Abstract

Information and communication technology (ICT)-supported home-based cardiac rehabilitation (HBCR) has gained prominence because of its potential advantages, including improved patient engagement. However, the long-term effects on patients with heart failure (HF) and physical frailty are unclear. The aim of this study was to determine the effects of HBCR on patients with HF and physical frailty 12 months after the HBCR intervention.

This single-centre, single-arm intervention trial included 30 outpatients with chronic HF and physical frailty or pre-frailty. Participants received a comprehensive ICT-based HBCR intervention, including disease management, exercise, and nutritional guidance for 3 months, followed by a 12-month period of ICT-supported self-management without professional guidance. The primary outcome was the change in 6-minute walking distance (6MWD).

The 6MWD of the patients significantly improved at 3 months, compared with baseline (395.8 ± 16.2 metres [95% confidence interval (CI): 363.0-428.6] vs 445.1 ± 16.3 metres [95% CI, 412.0-478.2]; P < 0.01), but it decreased at 15 months, compared with 3 months (417.7 ± 16.3 metres [95% CI: 384.6-450.8]; P = 0.04). The frailty score also decreased at the 3-month vs the 15-month timepoint. Patients who continued to exercise at 15 months showed sustained improvement in 6MWD.

At 12 months after the intervention, the initial improvements in exercise tolerance and frailty were not maintained in the overall cohort. The ICT-supported self-management approach used in this study was insufficient to promote sustained behavioural change over the long term.

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