Introduction: Cardiovascular diseases (CVD) are the leading cause of death in the Western world with substantial micro- and macro-economic burden. Several modifiable risk factors contribute to the pathogenesis of CVD which are all addressed during cardiac rehabilitation (CR). CR is conducted in three phases: I: acute care hospital, II: subsequent in- or outpatient CR, and III: out-patient CR with focus on lifelong prevention.
Methods: Despite its proven merits, the adherence to lifestyle changes following completion of CR phase II is challenging and the long-term preservation of achieved improvements e.g. in physical activity is sub-optimal. This gap is addressed in recent recommendations, suggesting that clinicians help patients to set personal goals to i) achieve and maintain the benefits of physical activity, ii) include physical activity into their daily routine and iii) overcome barriers to exercise to achieve behaviour change more effectively and more sustainably. We have developed tele-rehabilitation services to support patients during home-based exercise training in CR phase III. Our services provide a link between CR experts and patients by means of individualized exercise prescription supported by different kinds of wearables for measuring e.g. physical activity volume. Different ways for connecting the services to the Austrian health care infrastructure including Austria’s electronic health record (ELGA) are considered and partly implemented.
Results: The effectiveness of such services and other supportive measures regarding adherence to home training plans and changes in exercise capacity during phase III CR is currently evaluated in the EPICURE study (Evaluation of multi-modal supportive actions in outpatient cardiac rehabilitation in subjects with cardiovascular disease), which was started in autumn 2019 in five CR centres and will be finished in autumn 2020.
Conclusion: Tele-rehabilitation services have the potential to improve the outcome of CVD patients. However, clinical studies to evaluate the effectiveness of different supportive measures are needed.