Patients with heart failure with reduced ejection fraction (HFrEF) without type 2 diabetes mellitus (DM) experienced more pronounced improvements in ventilatory profile, physical performance, and gas exchange parameters from hybrid comprehensive telerehabilitation (HCTR) vs usual care (UC) than patients with HFrEF without DM, according to a study published in Cardiovascular Diabetology.
Cardiopulmonary exercise testing (CPET) has been demonstrated to be useful for quantifying aerobic capacity and identifying levels of exercise tolerance in patients with cardiovascular disease, as well as for assessment of functional capacity, hemodynamic abnormalities, and exercise-induced arrhythmias. However, data are limited regarding the efficacy of HCTR on cardiopulmonary exercise capacity in patients with HFrEF with vs without diabetes.
Investigators designed the Telerehabilitation in Heart Failure Patients trial (TELEREH-HF) to assess the impact of 9 weeks of HCTR vs UC on cardiopulmonary exercise capacity in HFrEF patients with vs without DM (ClinicalTrials.gov identifier: NCT02523560).
Patients included had clinically stable HF with left ventricular ejection fraction <40% after a hospitalization for worsening HF within the past 6 months. Participants were randomly assigned to HCTR or UC. Patients in the HCTR group exercised 5 times weekly on treadmills (1 week in hospital followed by 8 weeks at home), with exercise training supervised by a medical team of physiotherapists, physicians, nurses, and a psychologist.
CPET was performed using a system consisting of a remote device for tele-electrocardiogram-monitoring, mobile phone, and monitoring center.
A total of 850 patients were randomly assigned 1:1 to the HCTR group or the UC group. Of the total enrolled patients, 34.2% (291 of 850) had DM. Among the 425 HCTR participants, 385 underwent CPET twice pre- and post-telerehabilitation; 33.5% (129 of 385) had DM (HCTR-DM group) and 66.5% (256 of 385) did not (HCTR-non-DM group). Among the 425 UC patients, 397 underwent CPET twice; 34.5% (137 of 397) had DM (UC-DM group) and 65.5% (260 of 397) did not (UC-non-DM group).
From baseline to 9 weeks, differences in cardiopulmonary parameters among DM participants remained similar between HCTR and UC patients. However, among participants without DM, the HCTR intervention was associated with greater exercise time changes than UC: 56.7 s (95% CI, 46.1-67.3 s) vs 13.6 s (95% CI, 3.2-24.1; P <.001). This resulted in a statistically significant interaction between participants with vs without DM: the difference in exercise time changes between HCTR vs UC was 12.0 s (95% CI, −15.1 to 39.1 s) in the DM subset and 43.1 s (95% CI, 24.0-63.0 s) in the non-DM subset (P =.016).
Statistically significant differences in ventilation at rest between the DM and non-DM participants were also observed from the effect of HCTR vs UC: −0.34 L/min (95% CI, −1.60 to 0.91 L/min) in the DM subset and 0.83 L/min (95% CI, −0.06 to 1.73 L/min) in the non-DM subset (P =.0496); and in the ventilation/carbon dioxide slope: 1.52 (95% CI, −1.55 to 4.59) for the DM subset vs −1.44 (95% CI, −3.64 to 0.77) for the non-DM subset (P =.044).
These results suggest that the benefits of hybrid comprehensive telerehabilitation vs usual care was more pronounced in patients with HFrEF without DM.
Główczyńska R, Piotrowicz E, Szalewska D, et al. Effects of hybrid comprehensive telerehabilitation on cardiopulmonary capacity in heart failure patients depending on diabetes mellitus: subanalysis of the TELEREH-HF randomized clinical trial. Cardiovasc Diabetol. Published online May 13, 2021. doi: 10.1186/s12933-021-01292-9