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The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology

Open access
Scherrenberg, Martijn, Wilhelm, Matthias, Hansen, Dominique, Völler, Heinz, Cornelissen, Véronique, Frederix, Ines, Kemps, Hareld, Dendale, Paul·2021·European Journal of Preventive Cardiology
DOI 10.1177/2047487320939671PMC PMC7928994
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Abstract

The role of comprehensive cardiac rehabilitation is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity. However, the current COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe resulting in many eligible patients unable to participate in the optimisation of secondary prevention and physical performance. This elicits an even louder call for alternatives such as cardiac telerehabilitation to maintain the delivery of the core components of cardiac rehabilitation to cardiovascular disease patients. The present call for action paper gives an update of recent cardiac telerehabilitation studies and provides a practical guide for the setup of a comprehensive cardiac telerehabilitation intervention during the COVID-19 pandemic. This set up could also be relevant to any cardiovascular disease patient not able to visit cardiac rehabilitation centres regularly after the COVID-19 pandemic ceases.

Verified 2026-10-09 · 1 reference not checked yet

AI snapshot

Written from the paper’s full text.

TL;DR

This European Association of Preventive Cardiology call for action argues that COVID-19-related closure of centre-based cardiac rehabilitation makes cardiac telerehabilitation necessary to maintain secondary prevention. It reviews recent telerehabilitation evidence and provides practical guidance for remotely delivering core cardiac rehabilitation components.

Key findings

  • Cardiac telerehabilitation trials generally show home-based or remote exercise training is comparable to centre-based cardiac rehabilitation for exercise capacity and quality of life, with some trials reporting greater improvements, greater patient satisfaction, or cost-effectiveness; examples include TELEREHAB III, TRiCH, TELEREH-HF, Fit@Home, and Maddison et al.
  • Remote risk-factor management has supporting evidence: a meta-analysis of 104 trials with 111,653 patients found moderate-certainty evidence that proactive telephone counselling increases smoking quit rates; internet-based smoking cessation improved cessation probability by 29% short term and 19% long term; smartphone applications reduced HbA1c by 0.57% in type 2 diabetes; internet-based weight loss produced mean short-term weight loss of 2.13 kg but long-term loss of 0.17 kg.
  • Safety data cited state major cardiovascular complications during supervised exercise training for cardiovascular disease patients are about one per 50,000 patient-hours; for a centre seeing 500–1000 patients per year, this translates to approximately one major event per year. Remote assessment can use electronic medical records, telephone/video consultation, remote 6-minute walk test, the HUNT study tool, and self-monitoring, with low-intensity training advised and exercise avoided in acute COVID-19 until at least 2 days afebrile.
  • Practical setup recommendations include telephone, video consultation, text messaging, email, social media, and apps; privacy/GDPR-compliant systems and informed consent are advised. Remote monitoring can include blood pressure, weight, heart rate, glycaemia, and steps, with 5000 steps/day indicating sedentary lifestyle, 7000–10,000 steps/day for healthy adults, and 100 steps/minute as a reasonable moderate-intensity threshold.

Methods

  • Design: a call for action/position paper from the EAPC Secondary Prevention and Rehabilitation Section, not primary research; its stated aims are to call for remote cardiac rehabilitation during COVID-19, summarise recent cardiac telerehabilitation trials, and provide a practical guide for setting up remote cardiac rehabilitation.
  • Evidence base: narrative synthesis of existing trials and meta-analyses, with tables summarising recent cardiac telerehabilitation studies for coronary artery disease and telerehabilitation services in EAPC accredited centres.
  • Analysis: descriptive and narrative; no new patient data, systematic review, or formal meta-analysis is described.

Limitations

  • The paper states that more telerehabilitation research is needed because studies are limited and recent, conducted on selected and stabilised cardiac patients, and all performed in northern Europe; it also states there is no evidence that telerehabilitation improves participation rates, most trials focus only on exercise training and physical activity rather than all core components of cardiac rehabilitation, few trials assess recurrent events, rehospitalisations, and mortality, endpoints are prone to spontaneous recovery, and telerehabilitation studies rarely focus on phase I.
  • The paper also notes limited evidence for remotely delivered psychosocial or vocational support, small sample sizes and short durations in mobile-app hypertension studies, and that firm conclusions cannot be drawn for type 2 diabetes remote management because of relatively small trial sample sizes; more RCTs are needed for smoking cessation apps.
  • Evident from the text: as a call for action/position paper, the recommendations are expert guidance rather than a systematic evidence synthesis, and the COVID-19 pandemic context shapes the proposed implementation; the provided text also contains OCR gaps and truncated sections.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1177/2047487320939671

Cites

136 of 137 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 76 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    Due to the closure of CR centres during the COVID-19 pandemic, the centre-based patient assessment part of telerehabilitation services was not possible in EAPC accredited centres.

    “Due to the closure of CR centres during the COVID-19 pandemic the centre-based patient assessment part of following telerehabilitation services was not possible.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Multimodal interventions elicit greater survival benefits than exercise-only interventions.

    “Indeed, multimodal interventions have been shown to elicit greater survival benefits when compared with exercise-only interventions.9,10”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [9]

      Not checked in the free run.

    • cites [10] Müller-Riemenschneider, 2010, Effectiveness of nonpharmacological secondary prevention of coronary heart disease, Eur J Cardiovasc Prev Rehabil source

      Not checked in the free run.

  • Premisecitation

    Home-based intervention with telemonitoring and centre-based training had equal efficacy on physical fitness, physical activity level, and health-related quality of life.

    “Kraal et al. 28 found equal efficacy of the home-based intervention with telemonitoring and the centre-based training on physical fitness, physical activity level or health-related QoL.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Kraal, 2014, Effects of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: short-term results of the FIT@Home Study, Eur J Prev Cardiol source

      Not checked in the free run.

  • Premisenone given

    Most cardiac rehabilitation programmes are not personalised to the preferences of individual patients or subpopulations.

    “Furthermore, most CR programmes are not personalised to the preferences of individual patients or subpopulations.”
    Quote in the paperNot a substantial claim
  • Premisecitation

    Implementation of telerehabilitation in clinical practice and healthcare systems has remained disappointingly low.

    “During the past decade, different formats of telerehabilitation have been tested, yet implementation in clinical practice and in our healthcare systems has remained disappointingly low.22”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Frederix, 2019, ESC e-Cardiology Working Group Position Paper: Overcoming challenges in digital health implementation in cardiovascular medicine, Eur J Prev Cardiol source

      Not checked in the free run.

  • May combine two claims. 35
  • Classified as probably not a substantial claim. 23

  • May combine two claims.

    Premisecitation

    Comprehensive cardiac rehabilitation is effective and cost-effective in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity.

    “Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Home-based exercise training resulted in greater patient satisfaction and appeared more cost-effective than centre-based training.

    “However, the home-based exercise training resulted in greater patient satisfaction and appeared to be more costeffective than centre-based training.29”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29] Kraal, 2017, Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: results of the FIT@Home study, Eur J Prev Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Home-based cardiac rehabilitation and telerehabilitation programmes can overcome many practical barriers to cardiac rehabilitation participation and support long-term adherence to a healthy lifestyle.

    “Home-based CR and telerehabilitation programmes can overcome many of the practical barriers to CR participation and support longterm adherence to a healthy lifestyle.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Telerehabilitation intervention was effective at 9 weeks, significantly improving peak oxygen consumption and quality of life, and was well tolerated with no serious adverse events during exercise.

    “The authors concluded that the telerehabilitation intervention was effective at 9 weeks, with significantly improving peak oxygen consumption and QoL and it was well tolerated, with no serious adverse events during exercise.27”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    All trials included in Table 1 focus on phase II or phase III cardiac rehabilitation.

    “Furthermore, all trials included in Table 1 focus on phase II or phase III CR.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Barriers to cardiac rehabilitation participation can be divided into three levels: service and healthcare system, practical issues, and patient barriers.

    “Neubeck et al. 12 divided the barriers into three levels.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Neubeck, 2012, Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data, Eur J Prev Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Delaying the start of cardiac rehabilitation after a cardiac event is associated with less improvement in cardiopulmonary fitness, and poorer uptake, attendance and completion rates of cardiac rehabilitation programmes.

    “Moreover, there is compelling evidence that delaying the start of CR after a cardiac event is associated with less improvement in cardiopulmonary fitness, and poorer uptake, attendance and completion rates of CR programmes.17,18”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [17] Fell, 2016, Does the timing of cardiac rehabilitation impact fitness outcomes? An observational analysis, Open Heart source

      Not checked in the free run.

    • cites [18] Marzolini, 2015, Delays in referral and enrolment are associated with mitigated benefits of cardiac rehabilitation after coronary artery bypass surgery, Circ Cardiovasc Qual Outcomes source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most telerehabilitation trials have only focused on exercise training and physical activity, whereas ideally telerehabilitation should address all core components of cardiac rehabilitation tailored to the individual patient.

    “Furthermore, most telerehabilitation trials have only focussed on the exercise training and physical activity component, whereas ideally telerehabilitation should address all core components of CR tailored to the risk profile of the individual patient.23”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Janssen, 2013, Lifestyle modification programmes for patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials, Eur J Prev Cardiol source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    More telerehabilitation research is needed because studies up to now are limited and recent, conducted on selected and stabilised cardiac patients, and all trials have been performed in northern Europe.

    “Important to mention is the fact that more telerehabilitation research is still needed because studies up to now are limited and recent, conducted on selected and stabilised cardiac patients and all trials have been performed in northern Europe.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Cardiac rehabilitation plus telerehabilitation induced persistent health benefits and remained cost-effective up to 2 years after the intervention.

    “Moreover, Frederix et al. 25 demonstrated that this intervention (CR plus telerehabilitation) induced persistent health benefits and remained cost-effective up to 2 years after the intervention.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Frederix, 2017, Cardiac telerehabilitation: a novel cost-efficient care delivery strategy that can induce long-term health benefits, Eur J Prev Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Telerehabilitation intervention was not associated with an increase in the percentage of days alive and out of the hospital and did not reduce mortality and hospitalisation rate over 14-26 months compared with usual care.

    “However, the telerehabilitation intervention was not associated with an increase in the percentage of days alive and out of the hospital and did not reduce mortality and hospitalisation rate over a follow-up period of 14-26 months in comparison with usual care.27”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Home-based cardiac rehabilitation is equally effective as centre-based cardiac rehabilitation in improving clinical and health-related quality of life outcomes.

    “The authors concluded that home-based CR was equally effective in improving clinical and health-related QoL outcomes.22”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Frederix, 2019, ESC e-Cardiology Working Group Position Paper: Overcoming challenges in digital health implementation in cardiovascular medicine, Eur J Prev Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Low uptake of cardiac rehabilitation and poorer long-term adoption of secondary prevention measures are important causes of high rehospitalisation and recurrent events.

    “Important causes are the low uptake of CR and poorer long-term adoption of secondary prevention measures, as shown recently in the EuroAspire audits.1,11”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Bansilal, 2015, Global burden of CVD: focus on secondary prevention of cardiovascular disease, Int J Cardiol source

      Not checked in the free run.

    • cites [11]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    There is up to now no evidence that telerehabilitation can improve participation rates.

    “However, there is up to now no evidence that telerehabilitation can improve participation rates.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Rehospitalisation rates for heart failure and recurrent events for coronary artery disease patients remain high despite established effectiveness of secondary prevention and cardiac rehabilitation.

    “Although the core components and the effectiveness of secondary prevention and CR are well established, rehospitalisation rates for HF and recurrent events for CAD patients remain disappointingly high.3,4”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] Briffa, 2011, Population trends of recurrent coronary heart disease event rates remain high, Circ Cardiovasc Qual Outcomes source

      Not checked in the free run.

    • cites [4] Moita, 2019, One-year rehospitalisations for congestive heart failure in Portuguese NHS hospitals: a multilevel approach on patterns of use and contributing factors, BMJ Open source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Exercise capacity and quality of life endpoints are prone to spontaneous recovery and do not reflect the three pillars of secondary prevention.

    “These endpoints are prone to spontaneous recovery and do not reflect the three pillars of secondary prevention (e.g.healthy nutrition, adherence to medication, smoking cessation, body composition).26”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Avila, 2020, Home-based exercise with telemonitoring guidance in patients with coronary artery disease: does it improve long-term physical fitness?, Eur J Prev Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [30] Maddison, 2019, Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial, Heart source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Home-based exercise intervention was as effective as prolonged centre-based training and resulted in equal levels of exercise capacity and physical activity.

    “Avila et al. 26 concluded that the homebased exercise intervention was as effective as prolonged centrebased training and resulted in equal levels of exercise capacity and physical activity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Avila, 2020, Home-based exercise with telemonitoring guidance in patients with coronary artery disease: does it improve long-term physical fitness?, Eur J Prev Cardiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    No studies have evaluated the effects of telerehabilitation implementation on participation rates of cardiac rehabilitation.

    “Furthermore, no studies have evaluated the effects of telerehabilitation implementation on participation rates of CR.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Messaging results in decreased haemoglobin A1c and improved blood glucose control.

    “Two meta-analyses published in 2019 revealed that messaging results in decreased haemoglobin A1c (HbA1c) and improved blood glucose control.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [71] Huang, 2019, The effect of short message service intervention on glycemic control in diabetes: a systematic review and meta-analysis, Postgrad Med source

      Not checked in the free run.

    • cites [72] Haider, 2019, Mobile phone text messaging in improving glycaemic control for patients with type 2 diabetes mellitus: a systematic review and meta-analysis, Diabet Res Clin Pract source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Internet-based smoking cessation interventions improved the probability of cessation by 29% in the short term and by 19% in the long term compared with comparison groups.

    “A recent meta-analysis report by McCrabb et al. 42 in 2019 on the effectiveness of an internet-based smoking cessation intervention stated that these interventions improved the probability of cessation by 29% in the short term and by 19% in the long term when compared with comparison groups.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] McCrabb, 2019, Internet-based programs incorporating behavior change techniques are associated with increased smoking cessation in the general population: a systematic review and meta-analysis, Ann Behav Med: a publication of the Society of Behavioral Medicine source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Current evidence suggests that mobile applications are effective in improving blood pressure and medication compliance, but these studies had only small sample sizes and short durations.

    “Current evidence suggests that mobile applications are effective in improving BP and medication compliance; however, these studies had only small sample sizes and short durations.53”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Omboni, 2019, Connected health in hypertension management, Front Cardiovasc Med source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Effective methods for remote smoking cessation guidance include internet-based, text messaging-based, video consultation, and mobile application-based interventions.

    “In conclusion, effective methods for remote smoking cessation guidance include internet-based, text messaging-based, video consultation and mobile application-based interventions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A telephone follow-up intervention was no more effective than standard clinical care.

    “Another meta-analysis conducted in 2014 even concluded that a telephone follow-up intervention was no more effective than standard clinical care.65”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Suksomboon, 2014, Impact of phone call intervention on glycemic control in diabetes patients: a systematic review and meta-analysis of randomized, controlled trials, PLoS One source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Interactive and tailored internet-based interventions with or without additional behavioural support are moderately more effective than non-active controls at 6 months or longer, but there is no evidence they are better than other active smoking treatments.

    “The Cochrane Review of Taylor et al. 43 in 2017 concluded that interactive and tailored internet-based interventions with or without additional behavioural support are moderately more effective than non-active controls at 6 months or longer; however there was no evidence that these interventions were better than other active smoking treatments.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Taylor, 2017, Internet-based interventions for smoking cessation, Cochrane Database Syst Rev

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A smartphone application (CureApp smoking cessation) intervention resulted in high long-term continuous abstinence rates, high patient retention rates, and improvements in cessation-related symptoms.

    “In 2019, Masaki et al. 51 demonstrated that a smartphone application (CureApp smoking cessation) intervention resulted in high longterm continuous abstinence rates, high patient retention rates and improvements in cessation-related symptoms.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] Masaki, 2019, Impact of a novel smartphone app (CureApp smoking cessation) on nicotine dependence: prospective single-arm interventional pilot study, JMIR Mhealth Uhealth source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The effects of telephone counselling are more evident when combined with print-based self-help materials or brief face-to-face advice, and less pronounced when provided as an adjunct to pharmacotherapy.

    “The effects of telephone counselling appear more evident when it is provided in combination with print-based self-help materials, or brief face-to-face advice, and is less pronounced when provided as an adjunct to pharmacotherapy.38”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Matkin, 2019, Telephone counselling for smoking cessation, Cochrane Database Syst Rev

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    In temporarily closed CR centres with staff maintenance, remote patient assessment and delivery of telerehabilitation interventions is still possible.

    “However, in temporarily closed CR centres with staff maintenance remote patient assessment and delivery of telerehabilitation interventions is still possible.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A text-message intervention in HF patients is feasible and could possibly lead to improved HF self-management.

    “Furthermore, Nundy et al. 102 reported that a text-message intervention in HF patients is feasible and could possibly lead to improved HF self-management.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [102] Nundy, 2013, A text messaging intervention to improve heart failure self-management after hospital discharge in a largely African-American population: before-after study, J Med Internet Res source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most digitally delivered psychosocial interventions are forms of cognitive behavioural therapy and are based on existing face-to-face treatments.

    “Most digital delivered psychosocial interventions are forms of cognitive behavioural therapy and are based on existing face-to-face treatments.92”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [92] Andersson, 2014 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Internet-based digital interventions led to greater short-term weight loss (mean 2.13 kg) but not long-term weight loss (mean 0.17 kg) than offline interventions in overweight and obese adults.

    “A meta-analysis by Beleigoli et al. 81 demonstrated that internet-based digital interventions led to greater short-term (mean short-term weight loss was 2.13 kg) but not long-term weight loss (mean long-term weight loss was 0.17 kg) than offline interventions in overweight and obese adults.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] Beleigoli, 2019, Web-based digital health interventions for weight loss and lifestyle habit changes in overweight and obese adults: systematic review and meta-analysis, J Med Internet Res source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Telephone and video seem the most suitable approaches to deliver remote face-to-face psychosocial interventions.

    “Therefore, telephone and video seem the most suitable approaches to deliver remote face-to-face interventions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    An internet-based programme developed by Southard and team allows nurse case managers to deliver risk factor management training and education to patients with CAD, and was demonstrated to be cost-effective.

    “In 2003, Southard and team 99 developed and tested an internet-based programme that allows nurse case managers to deliver risk factor management training and education to patients with CAD.The authors demonstrated that this was a costeffective approach.99”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [99] Southard, 2003, Clinical trial of an internet-based case management system for secondary prevention of heart disease, J Cardiopulm Rehabil source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Low health literacy is associated with poorer overall health status, increased rehospitalisation and mortality, and higher healthcare use and costs in patients with cardiovascular disease.

    “A recent scientific statement from the American Heart Association 7 highlighted that limited health literacy is strongly associated with patient morbidity, mortality, healthcare use and costs.”
    • Also stated in: § Remote patient education · boosted
      “Numerous studies have demonstrated that low health literacy is associated with poorer overall health status and an increased likelihood of rehospitalisation and mortality.[94][95][96]”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [7] Magnani, 2018, Health literacy and cardiovascular disease: fundamental relevance to primary and secondary prevention: a scientific statement from the American Heart Association, Circulation source

      Not checked in the free run.

    • cites [94][95][96]

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Telephone counselling and text messaging seem feasible approaches for a quick set-up of remote education.

    “Multiple strategies can be used for remote education.In particular, telephone counselling and text messaging seem feasible approaches for a quick set-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    The lack of exercise testing results makes taking safety decisions and training in heart rate zones difficult.

    “The lack of exercise testing results makes taking safety decisions and training in heart rate zones difficult.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An online education platform for patients with atrial fibrillation was concluded to be an effective strategy to improve AF knowledge.

    “Desteghe et al. 100 tested an online education platform for patients with atrial fibrillation (AF).They concluded that it was an effective strategy to improve AF knowledge.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [100] Desteghe, 2018, Effectiveness and usability of an online tailored education platform for atrial fibrillation patients undergoing a direct current cardioversion or pulmonary vein isolation, Int J Cardiol source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Multimodal behavioural interventions, integrating health education, exercise training and psychological therapy, are recommended by European guidelines because of their importance in affecting cardiovascular prognosis, treatment adherence and quality of life.

    “Multimodal behavioural interventions, integrating health education, exercise training and psychological therapy are recommended by the European guidelines because of their importance in affecting cardiovascular prognosis, treatment adherence and QoL.[33][34][35][36][37]”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [33] Knuuti, 2020, 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: the Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC), Eur Heart J source

      Not checked in the free run.

    • cites [34]

      Not checked in the free run.

    • cites [35] Ibanez, 2018, 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC, Eur Heart J source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There are well-established digital treatments for depression and most anxiety disorders, and for problems such as insomnia for the general population.

    “However, there are well established digital treatments for depression and most of the anxiety disorders, and for problems such as insomnia for the general population.91”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [91] Andersson, 2014, Advantages and limitations of Internet-based interventions for common mental disorders, World Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    All studies of remote 6-minute walking test used self-developed applications, which makes it difficult to implement these quickly in all European centre-based CR.

    “However, all these studies used self-developed applications which makes it difficult to implement these quickly in all in European centre-based CR.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [104][105][106]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Educational interventions in comprehensive CR programmes may reduce fatal and non-fatal cardiovascular events and improve health-related quality of life.

    “Educational interventions in comprehensive CR programmes may reduce fatal and non-fatal cardiovascular events and improve health-related QoL.97”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [97] Anderson, 2017, Patient education in the management of coronary heart disease, Cochrane Database Syst Rev

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Telephone support interventions during CR may help reduce feelings of anxiety and depression and improve blood pressure and smoking cessation.

    “A meta-analysis by Kotb et al. 98 revealed that telephone support interventions during CR may help reduce feelings of anxiety and depression as well as improve BP and smoking cessation.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [98] Kotb, 2014, The effect of telephone support interventions on coronary artery disease (CAD) patient outcomes during cardiac rehabilitation: a systematic review and meta-analysis, PLoS One source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    During the COVID-19 pandemic, cardiologists can only make a decision on the safety of exercise based on the medical history of the patient, latest electrocardiogram, results of the revascularisation procedure and the left ventricular function on latest echocardiography, as well as personal contact by phone or video call.

    “During the COVID-19 pandemic, cardiologists can only make a decision on the safety of exercise based on the medical history of the patient, latest electrocardiogram, results of the revascularisation procedure and the left ventricular function on latest echocardiography, as well as personal contact by phone or video call.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Text messaging, telephone and video consultation, and social media are simple and affordable ways to deliver the core components of CR to the patient.

    “Text messaging, telephone and video consultation, and social media are simple and affordable ways to deliver the core components of CR to the patient.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients have access to text messaging, telephone, video consultation, and social media.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    Video consultations have the advantage that patients and health professionals can see each other, which allows non-verbal communication and can potentially improve the trust bond and reduce anxiety and the feeling of being left alone in difficult times.

    “In particular, video consultations have the advantage that patients and health professionals can see each other, which allows non-verbal communication and can potentially improve the trust bond and reduce anxiety and the feeling of being left alone in difficult times.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    The COVID-19 pandemic has created the need for cardiac telerehabilitation, as the only possible intervention due to the temporary closure of centre-based CR programmes, limited centre resources, restricted patient travel and limited infrastructure for safe group interventions.

    “Yet, the COVID-19 pandemic has created the need for cardiac telerehabilitation, as the only possible intervention due to the temporary closure of centre-based CR programmes, limited centre resources, restricted patient travel and limited infrastructure for safe group interventions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    All telecommunication media except for self-developed smartphone applications and internet-based interventions are very feasible and can be quickly adopted in every CR centre.

    “All of them except for self-developed smartphone applications and internet-based interventions are very feasible and can be quickly adopted in every CR centre.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    For home-based CR and telerehabilitation, safety assessment is important because patients will exercise without the supervision of health professionals.

    “For home-based CR and telerehabilitation safety assessment is important because patients will exercise without the supervision of health professionals.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Using these digital interventions offers the possibility to get experience with them among a large and heterogeneous group of patients across Europe, which could support the future study and implementation of telerehabilitation in standard care.

    “This offers the possibilities to get experience with these digital interventions among a large and heterogeneous group of patients across Europe, which could support the future study and implementation of telerehabilitation in standard care.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Patients have access to text messaging, telephone, video consultation, and social media.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    The past decade's telerehabilitation has been investigated in the search for an alternative for centre-based programmes or to support the effectiveness of CR in the longer term.

    “The past decade's telerehabilitation has been investigated in the search for an alternative for centre-based programmes or to support the effectiveness of CR in the longer term.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    All telecommunication media (telephones, video consultation, the internet, smartphone applications, text messaging, email and social media) can be used for bidirectional communication between health professionals and patients.

    “All can be used for bidirectional communication between health professionals and patients.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Screening tools for exercise training such as physical activity anamnesis could aid cardiologists or physical therapists in the decision on safety of exercise.

    “Screening tools for exercise training such as physical activity anamnesis could aid cardiologists or physical therapists in the decision.124,125”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [124] Warburton, 2011, Evidence-based risk assessment and recommendations for physical activity clearance: an introduction, Appl Physiol Nutr Metab source

      Not checked in the free run.

    • cites [125] Warburton, 2011, The physical activity readiness questionnaire for everyone (PAR-Qfl) and electronic physical activity readiness medical examination (ePARmed-Xfl), Health Fitness J Canada

      Not checked in the free run.

52 of 52

  • The paper relies on this without support.

    The COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe.

    “However, the current COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe resulting in many eligible patients unable to participate in the optimisation of secondary prevention and physical performance.”

  • The paper relies on this without support.

    Centre-based cardiac rehabilitation programmes have been closed in the majority of European countries.

    “This also includes centre-based CR programmes in the majority of European countries.”

  • The paper relies on this without support.

    Many centres are now exploring feasible options for the remote delivery of personalised cardiac rehabilitation services to a large and heterogeneous group of patients.

    “Hence, many centres are now exploring feasible options for the remote delivery of personalised CR services to a large and heterogeneous group of patients.”

  • The paper relies on this without support.

    Patients have access to text messaging, telephone, video consultation, and social media.

    “Text messaging, telephone and video consultation, and social media are simple and affordable ways to deliver the core components of CR to the patient.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The main reason for the upsurge of publications in 2021 may be attributed to the increase of pulse oximetry for triage in patients because of the COVID-19 pandemic and recent concern about accuracy across all skin types.

    “The main reason for this surge may be attributed to the increase of this technique for triage in patients because of the current COVID-19 pandemic [12,13,14,15,16,17], and also because of the recent concern about the accuracy of these devices across all skin types [20,57,58,59,60,61].”

    From Skin pigmentation influence on pulse oximetry accuracy: a systematic review and bibliometric analysis (2022) · cites this paper as [12]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Kraal study year differs from its reference

    Minor

    Table 1 dates Kraal et al. reference 28 to 2017, but reference 28 lists a 2014 publication. A separate Kraal paper appears as reference 29 in 2017.

  • Avila study year differs from its reference

    Minor

    Table 1 dates the cited Avila study to 2019, while reference 26 lists it as published in 2020.

  • A cited European guideline is listed as a cohort study

    Minor

    The statement cites references 33-37 as European guidelines, but reference 37 is titled as a community cohort study rather than a guideline.

  • NICE framework is cited to the EU regulation

    Minor

    The text cites reference 130 for the NICE evidence-tier framework, but reference 130 is an EU regulation. The NICE framework is listed as reference 131.

4 of 4

Cites

Flagged first, then by citations

2 of the 139 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Beck, 1996, Manual for the Beck Depression Inventory-II

Cited by

Sorted by citations

Related

Authors
Scherrenberg, M., Wilhelm, M., Hansen, D., Völler, H., Cornelissen, V., Frederix, I., Kemps, H., & Dendale, P.
Affiliations
  • Jessa Hospital (BE)
  • University Hospital of Bern (CH)
  • University of Potsdam (DE)
  • KU Leuven (BE)
  • University of Antwerp (BE)
  • Máxima Medisch Centrum (NL)
Corresponding author
Dendale, Paul
ORCID
Venue
European Journal of Preventive Cardiology
Publisher
Oxford University Press (OUP)
Published
2020-07-03
Volume
28
Issue
5
Pages
524-540
ISSN
  • 2047-4873 (ISSN-L)
  • 2047-4881
DOI
10.1177/2047487320939671
PMC
PMC7928994
OpenAlex
W3039903958
Semantic Scholar
50d105c1b9a8b2135d24962ad6f9fea2b843309e
Cited by
251
References
139
Citations by year
2026: 19 · 2025: 23 · 2024: 31 · 2023: 51 · 2022: 48 · 2021: 68 · 2020: 11
FWCI
27.54
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Preventive Cardiology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion)
  • Document Server@UHasselt (UHasselt) (submittedVersion)
  • publish.UP (University of Potsdam) (submittedVersion)
  • Lirias (KU Leuven) (submittedVersion, other-oa)
  • Lirias (KU Leuven) (submittedVersion)
  • TU/e Research Portal (submittedVersion)
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, COVID-19 pandemic, cardiac rehabilitation, secondary prevention, cardiovascular disease, coronary artery disease, heart failure, exercise capacity, quality of life, cardiovascular mortality, remote patient monitoring

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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