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Cardiac risk factors and prevention
Original research article
Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial
  1. Ralph Maddison1,2,
  2. Jonathan Charles Rawstorn1,2,
  3. Ralph A H Stewart3,
  4. Jocelyne Benatar3,
  5. Robyn Whittaker2,
  6. Anna Rolleston4,
  7. Yannan Jiang2,
  8. Lan Gao5,
  9. Marj Moodie5,
  10. Ian Warren6,
  11. Andrew Meads6,
  12. Nicholas Gant7
  1. 1 Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
  2. 2 National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
  3. 3 Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
  4. 4 The Centre for Health, Tauranga, New Zealand
  5. 5 Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
  6. 6 Department of Computer Science, University of Auckland, Auckland, New Zealand
  7. 7 Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
  1. Correspondence to Dr Jonathan Charles Rawstorn, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia; jonathan.rawstorn{at}deakin.edu.au

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 (V̇O2max, 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 V̇O2max 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. V̇O2 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.

  • coronary artery disease
  • cardiac rehabilitation
  • ehealth/telemedicine/mobile health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/heartjnl-2018-313189

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    Footnotes

    • Contributors RM conceived the study and is the guarantor. RM, JCR, RW, YJ and NG designed the study. RM and JCR implemented the trial at the Auckland site and drafted the manuscript. RM, JCR, IW and AM developed the REMOTE-CR platform. RAHS and JB provided clinical oversight during study design and conduct. AR implemented the trial at the Tauranga site. YJ wrote the statistical analysis plan and conducted primary and secondary analyses. LG and MM conducted the economic analyses. All authors revised the manuscript, approved the final version and agreed to be accountable for all aspects of the work.

    • Funding This work was supported by the Auckland Medical Research Foundation (1113020). AMRF had no input into the trial design, conduct, analysis, reporting or decision to submit this manuscript for publication.

    • Competing interests RM was supported by the New Zealand Health Research Council (Sir Charles Hercus health research fellowship). MM is supported by the Australian National Health and Medical Research Council (Centre for Research Excellence, 1041020). We declare no further competing interests.

    • Patient consent Not required.

    • Ethics approval University of Auckland Human Participants Ethics Committee (011021).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Requests for deidentified individual participant data or study documents will be considered where the proposed use aligns with public good purposes, does not conflict with other requests or planned use by the trial steering committee, and the requestor is willing to sign a data access agreement.

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