An at-home, mobile application-guided telemonitored cardiac rehabilitation program may lead to improvements in physical fitness, program adherence, and health beliefs in patients who have undergone ablation for atrial fibrillation, according to research results published in Clinical Rehabilitation.

Researchers sought to evaluate the short-term effectiveness of a home-based cardiac telerehabilitation program vs standard cardiac rehabilitation for patients who underwent ablation for atrial fibrillation.

Adult inpatients at a tertiary care center in Jiangsu Province, China, were enrolled in the current study (ClinicalTrials.gov Identifier NCT04414007) between February and July 2019. Patients who completed a catheter ablation for atrial fibrillation were included in the study.


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Following enrollment, patients were randomly assigned 1:1 to receive either telerehabilitation (intervention group; n=50) or a conventional 12-week rehabilitation treatment (control group; n=50). Patients in the intervention group received, in addition to standard rehabilitative care, a home-based, patient-tailored, mobile application-guided, portable electrocardiogram device-monitored telerehabilitation program that provided an individual training prescription to each participant.

Primary endpoint was improvement in VO2peak; secondary endpoints included adherence, physical activity, and beliefs related to cardiovascular disease and exercise self-efficacy. 

The total cohort included 100 patients, of whom 97 completed follow-up. At baseline, between-group demographic and clinical parameters were well matched, and mean VO2peak was not significantly different. Scores of the Health Beliefs Related to Cardiovascular Disease Scale and Exercise Self-Efficacy Scale questionnaires were similar between groups.

Compared with baseline, after 12 weeks of exercise training, participants in both groups experienced significant increases in VO2peak (P <.01 for both groups). Questionnaire scores also significantly increased after 12 weeks of cardiac rehabilitation.

In terms of physical activity, measured by the International Physical Activity Questionnaire, there were no significant between-group differences at baseline. However, after 12 weeks, both groups experienced significant increases in physical activity. Patients in the intervention vs control group had significantly higher levels of physical activity. Patients in the intervention group reported that their aerobic capacity was increased, and results for all questions were improved. Overall, patients in the intervention group “had more faith that they would benefit from [a] healthy lifestyle, felt more confident in the current exercise mode, and were more likely to insist on continuing the rehabilitation program” after the study period concluded.

In the intervention group, patients had a program adherence of 9.6±3.1 of the 12 weeks, compared with an adherence of 5.0±3.8 in the control group.

At the 3-month follow-up, 3 patients in each group (6.1% and 6.5% of the intervention and control groups, respectively) experienced a recurrent atrial arrhythmia after ablation. However, none of the patients experienced injuries or needed hospitalization due to recurrent atrial fibrillation episodes resulting from the rehabilitation program participation.

Study limitations included the small sample size and the single center at which it was conducted. The use of a smartphone for the intervention group both eliminated eligible patients who did not have access to this technology and ensured that participants were generally younger and well-educated than the general population.

“Cardiac rehabilitation is necessary and valuable in patients who have undergone ablation for atrial fibrillation,” the researchers concluded. “Our proposed cardiac rehabilitation program provides a promising supplemental or alternative option to conventional modes, especially under circumstances preventing patients from accessing center-based cardiac rehabilitation.”

Reference

Cai C, Bao Z, Wu N, et al. A novel model of home-based, patient-tailored and mobile application-guided cardiac telerehabilitation in patients with atrial fibrillation: A randomized controlled trial. Clin Rehabil. Published online July 16, 2021. doi:10.1177/02692155211032372