Cited by 320Cardiac Health and Mental HealthTelemedicine and Telehealth ImplementationMobile Health and mHealth Applications

Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial

Open access
Maddison, Ralph, Rawstorn, Jonathan Charles, Stewart, Ralph A H, Benatar, Jocelyne, Whittaker, Robyn, Rolleston, Anna, Jiang, Yannan, Gao, Lan +4 more·2019·Heart

Abstract

Objective: Compare the effects and costs of remotely monitored exercise-based cardiac telerehabilitation (REMOTE-CR) with centre-based programmes (CBexCR) in adults with coronary heart disease (CHD). Methods: Participants were randomised to receive 12 weeks of telerehabilitation or centre-based rehabilitation. REMOTE-CR provided individualised exercise prescription, real-time exercise monitoring/coaching and theory-based behavioural strategies via a bespoke telerehabilitation platform; CBexCR provided individualised exercise prescription and coaching via established rehabilitation clinics. Outcomes assessed at baseline, 12 and/or 24 weeks included maximal oxygen uptake (V̇O 2 max, primary) modifiable cardiovascular risk factors, exercise adherence, motivation, health-related quality of life and programme delivery, hospital service utilisation and medication costs. The primary hypothesis was a non-inferior between-group difference in V̇O 2 max at 12 weeks (inferiority margin=−1.25 mL/kg/min); inferiority margins were not set for secondary outcomes. Results: 162 participants (mean 61±12.7 years, 86% men) were randomised. V̇O 2 max was comparable in both groups at 12 weeks and REMOTE-CR was non-inferior to CBexCR (REMOTE-CR-CBexCR adjusted mean difference (AMD)=0.51 (95% CI −0.97 to 1.98) mL/kg/min, p=0.48). REMOTE-CR participants were less sedentary at 24 weeks (AMD=−61.5 (95% CI −117.8 to −5.3) min/day, p=0.03), while CBexCR participants had smaller waist (AMD=1.71 (95% CI 0.09 to 3.34) cm, p=0.04) and hip circumferences (AMD=1.16 (95% CI 0.06 to 2.27) cm, p=0.04) at 12 weeks. No other between-group differences were detected. Per capita programme delivery (NZD1130/GBP573 vs NZD3466/GBP1758) and medication costs (NZD331/GBP168 vs NZD605/GBP307, p=0.02) were lower for REMOTE-CR. Hospital service utilisation costs were not statistically significantly different (NZD3459/GBP1754 vs NZD5464/GBP2771, p=0.20). Conclusion: REMOTE-CR is an effective, cost-efficient alternative delivery model that could—as a complement to existing services—improve overall utilisation rates by increasing reach and satisfying unique participant preferences.

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Crossref · 10.1136/heartjnl-2018-313189

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  • Home-based cardiac telerehabilitation using wearable sensors is equivalent or better than centre-based rehabilitation and can increase access to cardiac rehabilitation and reduce the cost.

    “Home-based cardiac telerehabilitation using wearable sensors is equivalent or better than centre-based rehabilitation and can increase access to cardiac rehabilitation and reduce the cost”
  • REMOTE-CR was associated with less sedentary time at 24 weeks and was more cost-effective than the centre-based programme.

    “A non-inferiority, randomized trial comparing REMOTE-CR — a real-time, remote telerehabilitation platform that includes the use of a chest-worn wearable sensor (BioHarness 3, Zephyr Technology, USA) — with a centre-based programme showed that REMOTE-CR was associated with less sedentary time at 24 weeks and was more cost-effective than the centre-based programme85.”
  • A smartphone and chest-worn sensor telerehabilitation intervention was an effective and cost-effective delivery model that could potentially improve overall cardiac rehabilitation utilisation rates by increasing reach and satisfying unique participant preferences.

    “The authors demonstrated that the intervention was an effective and cost-effective delivery model that could potentially improve overall CR utilisation rates by increasing reach and satisfying unique participant preferences.30”

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Authors
Maddison, R., Rawstorn, J. C., Stewart, R. A. H., Benatar, J., Whittaker, R., Rolleston, A., Jiang, Y., Gao, L., Moodie, M., Warren, I., Meads, A., & Gant, N.
Affiliations
  • Deakin University (AU)
  • Auckland City Hospital (NZ)
  • University of Auckland (NZ)
  • The Centre for Health (New Zealand) (NZ)
Corresponding author
Rawstorn, Jonathan Charles
Venue
Heart
Publisher
BMJ
Published
2018-08-27
Volume
105
Issue
2
Pages
122-129
ISSN
  • 1355-6037 (ISSN-L)
  • 1468-201X
OpenAlex
W2889374857
Cited by
320
References
32
Citations by year
2026: 27 · 2025: 47 · 2024: 52 · 2023: 55 · 2022: 59 · 2021: 36 · 2020: 25 · 2019: 14 · 2018: 5
FWCI
15.13
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Heart (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Own your potential (DEAKIN) (submittedVersion)
  • Figshare (submittedVersion, cc-by-nc)
  • HighWire Press Open Archive (submittedVersion)
Funders
Auckland Medical Research Foundation
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
cardiac telerehabilitation, coronary artery disease, exercise-based cardiac rehabilitation, VO2max, sedentary behavior, cardiovascular risk factors, health-related quality of life, drug costs, non-inferiority, behavioral strategies, exercise adherence, motivation, New Zealand
MeSH terms
Coronary Disease, Cost-Benefit Analysis, Exercise Therapy, Female, Humans, Male, Middle Aged, New Zealand, Quality of Life, Rehabilitation Centers, Treatment Outcome, Telemedicine, Internet

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