Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial.
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.
['Maddison|Ralph|R|', 'Rawstorn|Jonathan Charles|JC|0000-0002-9755-7993', 'Stewart|Ralph A H|RAH|', 'Benatar|Jocelyne|J|', 'Whittaker|Robyn|R|0000-0003-0901-9149', 'Rolleston|Anna|A|', 'Jiang|Yannan|Y|0000-0002-7663-9164', 'Gao|Lan|L|', 'Moodie|Marj|M|', 'Warren|Ian|I|', 'Meads|Andrew|A|', 'Gant|Nicholas|N|0000-0001-9740-0163']
D003327:Coronary Disease D003362:Cost-Benefit Analysis D005081:Exercise Therapy D005260:Female D006801:Humans D020407:Internet D008297:Male D008875:Middle Aged D009520:New Zealand D011788:Quality of Life D012047:Rehabilitation Centers D017216:Telemedicine D016896:Treatment Outcome
cardiac rehabilitation coronary artery disease ehealth/telemedicine/mobile health