Telecardiology Center, Institute of Cardiology, Warszawa, Poland.
Eur J Prev Cardiol. 2013 Jun;20(2 Suppl):12-6. doi: 10.1177/2047487313487483c.
Coronary heart disease is a leading cause of death globally. Cardiac rehabilitation (CR) programs reduce recurrent events, improve risk factors and enhance quality of life through physical activity and education. However, only one-third of eligible patients attend a CR program. Availability of such programs is limited particular in areas with low levels of development and low population density. Therefore, innovative models for secondary prevention are necessary to increase access by adaption of such programs to the diversity of people and communities. Monitoring cardiovascular risk factors seems to be particularly appropriate for the use of telemedicine. This includes health applications to improve lifestyle by surveillance, education, psychological support and interactive motivational tools with the final goal of reducing metabolic risk factors and reducing cardiovascular morbidity and mortality. So far, telemedical studies have mostly investigated electrocardiogram (ECG)-monitored exercise training at home and internet-based counseling for lifestyle modification in selected low-risk patients after an acute cardiac event. First reports of telerehabilitation in patients with heart failure are also promising. However, we need large scale prospective randomized studies to show that cardiac telerehabilitation is equally effective as it has been shown for exercise-based outpatient CR programs which are provided according to current standards and guidelines. Cardiac telerehabilitation is a promising new tool in particular to include patients in CR which are not living near a center-based CR program or who are not able to attend such a program for various reasons and to improve long-term adherence to a healthy lifestyle after center-based CR.
冠心病是全球范围内的主要致死病因。心脏康复（CR）项目通过身体活动和教育，减少复发事件，改善风险因素，提高生活质量。然而，只有三分之一符合条件的患者会参加 CR 项目。由于此类项目的可用性有限，特别是在发展水平低和人口密度低的地区。因此，需要创新的二级预防模式，通过调整此类项目以适应人群和社区的多样性，来增加其可及性。监测心血管风险因素似乎特别适合使用远程医疗。这包括通过监测、教育、心理支持和互动激励工具来改善生活方式的健康应用，最终目标是降低代谢风险因素，减少心血管发病率和死亡率。到目前为止，远程医疗研究主要调查了在家中进行心电图（ECG）监测的运动训练，以及针对急性心脏事件后特定低危患者的生活方式改变的基于互联网的咨询。远程康复在心力衰竭患者中的初步报告也很有前景。然而，我们需要进行大规模的前瞻性随机研究，以证明心脏远程康复与根据当前标准和指南提供的基于运动的门诊 CR 项目同样有效。心脏远程康复是一种很有前途的新工具，特别是可以让那些居住在中心 CR 项目附近的患者、或因各种原因无法参加此类项目的患者，以及那些参加中心 CR 项目后难以长期坚持健康生活方式的患者，都能够参与到 CR 项目中。
