THE EFFECTS OF HYBRID CARDIAC REHABILITATION USING SYNCHRONIZED TELEHEALTH ON PATIENT
Cardiac rehabilitation is effective for secondary prevention of cardiac events and is endorsed by consensus guidelines but is limited by low enrollment and completion rates. Non-traditional delivery models that facilitate participation in CR are needed. The improving ATTENDance (iATTEND) to CR trial is an open label, single-site trial that compared standard facility-based only CR (FBCR) to hybrid CR (HYCR = patient-individualized combination of virtual CR delivered via synchronized telehealth and up to 12 in-facility CR sessions). Qualifying patients enrolling into early outpatient CR were consented and randomized 1:1 to HYCR (n=142) or FBCR (n=140). Primary outcome was total number of CR sessions completed within 6 mo. Secondary outcomes were percent of patients completing all 36 prescribed CR sessions and changes (after CR – before CR) in exercise capacity (peak oxygen uptake, VO2; 6-minute walk distance, 6MWD). Both attendance outcomes (alpha set at p<0.05) and both exercise capacity outcomes [examined using the TOST (two, one sided tests) equivalence test] were adjusted for relevant, pre-specified co-variates. Among patients enrolled into iATTEND (54% Black race, 33%; women, 34% > 65 yr), neither the total number of CR sessions completed per patient (28.7 + 11.8 vs 27.6 + 11.8 visits, adjusted p = 0.41) nor percent of patients completing 36 sessions (58.5 + 4.1 vs 50.7 + 4.2%, adjusted p=0.32) were different between HYCR and FBCR, respectively. After CR, changes in peak VO2 (mL.kg.-1min-1) were 2.3 + 2.8 vs 1.9 + 2.8 (HYCR and FBCR, respectively; adjusted p=0.78) and changes in 6MWD (m) were 46 + 46 vs 55 + 53 (HYCR and FBCR, respectively; adjusted p=0.18); TOST indicated equivalency (p=.001) between groups for both measures of change in exercise capacity. Across 7,735 total CR sessions, there was one major adverse event (non-fatal stroke within 3 hr after CR in HYCR) and no falls requiring medical attention. In a diverse cohort of patients that included understudied groups, our data suggest that HYCR is an effective non-traditional model to deliver CR. When compared to standard FBCR, HYCR results in similar patient attendance patterns and equivalent improvements in exercise capacity. (Funded by: National Heart, Lung, and Blood Institute)BACKGROUND
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Contributor Notes
First author's contact: SKeteyi1@hfhs.org