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Effectiveness of Home-Based Mobile Guided Cardiac Rehabilitation as Alternative Strategy for Nonparticipation in Clinic-Based Cardiac Rehabilitation Among Elderly Patients in Europe: A Randomized Clinical Trial.

  • Snoek, Johan A1, 2
  • Prescott, Eva I3
  • van der Velde, Astrid E1
  • Eijsvogels, Thijs M H4
  • Mikkelsen, Nicolai3
  • Prins, Leonie F5
  • Bruins, Wendy
  • Meindersma, Esther6
  • González-Juanatey, José R7
  • Peña-Gil, Carlos7
  • González-Salvado, Violeta7
  • Moatemri, Feriel8
  • Iliou, Marie-Christine8
  • Marcin, Thimo9
  • Eser, Prisca9
  • Wilhelm, Matthias9
  • Van't Hof, Arnoud W J10, 11
  • de Kluiver, Ed P1
  • 1 Isala Heart Center, Zwolle, the Netherlands. , (Netherlands)
  • 2 Sports Medicine Department Isala, Zwolle, the Netherlands. , (Netherlands)
  • 3 Department of Cardiology, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark. , (Denmark)
  • 4 Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the Netherlands. , (Netherlands)
  • 5 Diagram, Zwolle, the Netherlands. , (Netherlands)
  • 6 Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands. , (Netherlands)
  • 7 Department of Cardiology, Hospital Clínico Universitario de Santiago, Instituto de Investigación Sanitaria, CIBER CV, Madrid, Spain. , (Spain)
  • 8 Department of Cardiac Rehabilitation, Assistance Publique Hopitaux de Paris, Paris, France. , (France)
  • 9 Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. , (Switzerland)
  • 10 Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands. , (Netherlands)
  • 11 Department of Cardiology, Zuyderland Medical Center, Heerlen, the Netherlands. , (Netherlands)
Published Article
JAMA cardiology
Publication Date
Apr 01, 2021
DOI: 10.1001/jamacardio.2020.5218
PMID: 33112363


Although nonparticipation in cardiac rehabilitation is known to increase cardiovascular mortality and hospital readmissions, more than half of patients with coronary artery disease in Europe are not participating in cardiac rehabilitation. To assess whether a 6-month guided mobile cardiac rehabilitation (MCR) program is an effective therapy for elderly patients who decline participation in cardiac rehabilitation. Patients were enrolled in this parallel multicenter randomized clinical trial from November 11, 2015, to January 3, 2018, and follow-up was completed on January 17, 2019, in a secondary care system with 6 cardiac institutions across 5 European countries. Researchers assessing primary outcome were masked for group assignment. A total of 4236 patients were identified with a recent diagnosis of acute coronary syndrome, coronary revascularization, or surgical or percutaneous treatment for valvular disease, or documented coronary artery disease, of whom 996 declined to start cardiac rehabilitation. Subsequently, 179 patients who met the inclusion and exclusion criteria consented to participate in the European Study on Effectiveness and Sustainability of Current Cardiac Rehabilitation Programmes in the Elderly trial. Data were analyzed from January 21 to October 11, 2019. Six months of home-based cardiac rehabilitation with telemonitoring and coaching based on motivational interviewing was used to stimulate patients to reach exercise goals. Control patients did not receive any form of cardiac rehabilitation throughout the study period. The primary outcome parameter was peak oxygen uptake (Vo2peak) after 6 months. Among 179 patients randomized (145 male [81%]; median age, 72 [range, 65-87] years), 159 (89%) were eligible for primary end point analysis. Follow-up at 1 year was completed for 151 patients (84%). Peak oxygen uptake improved in the MCR group (n = 89) at 6 and 12 months (1.6 [95% CI, 0.9-2.4] mL/kg-1/min-1 and 1.2 [95% CI, 0.4-2.0] mL/kg-1/min-1, respectively), whereas there was no improvement in the control group (n = 90) (+0.2 [95% CI, -0.4 to 0.8] mL/kg-1/min-1 and +0.1 [95% CI, -0.5 to 0.7] mL/kg-1/min-1, respectively). Changes in Vo2peak were greater in the MCR vs control groups at 6 months (+1.2 [95% CI, 0.2 to 2.1] mL/kg-1/min-1) and 12 months (+0.9 [95% CI, 0.05 to 1.8] mL/kg-1/min-1). The incidence of adverse events was low and did not differ between the MCR and control groups. These results suggest that a 6-month home-based MCR program for patients 65 years or older with coronary artery disease or a valvular intervention was safe and beneficial in improving Vo2peak when compared with no cardiac rehabilitation. Identifier: NL5168.

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