Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan.
Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan.
ESC Heart Fail. 2022 Aug;9(4):2407-2418. doi: 10.1002/ehf2.13934. Epub 2022 May 9.
Cardiac rehabilitation (CR) is an evidence-based, secondary preventive strategy that improves mortality and morbidity rates in patients with heart failure (HF). However, the implementation and continuation of CR remains unsatisfactory, particularly for outpatients with physical frailty. This study investigated the efficacy and safety of a comprehensive home-based cardiac rehabilitation (HBCR) programme that combines patient education, exercise guidance, and nutritional guidance using information and communication technology (ICT).
This study was a single-centre, open-label, randomized, controlled trial. Between April 2020 and November 2020, 30 outpatients with chronic HF (New York Heart Association II-III) and physical frailty were enrolled. The control group (n = 15) continued with standard care, while the HBCR group (n = 15) also received comprehensive, individualized CR, including ICT-based exercise and nutrition guidance using ICT via a Fitbit® device for 3 months. The CR team communicated with each patient in HBCR group once a week via the application messaging tool and planned the training frequency and intensity of training individually for the next week according to each patient's symptoms and recorded pulse data during exercise. Dietitians conducted a nutritional assessment and then provided individual nutritional advice using the picture-posting function of the application. The primary outcome was the change in the 6 min walking distance (6MWD). The participants' mean age was 63.7 ± 10.1 years, 53% were male, and 87% had non-ischaemic heart disease. The observed change in the 6MWD was significantly greater in the HBCR group (52.1 ± 43.9 m vs. -4.3 ± 38.8 m; P < 0.001) at a 73% of adherence rate. There was no significant change in adverse events in either group.
Our comprehensive HBCR programme using ICT for HF patients with physical frailty improved exercise tolerance and improved lower extremity muscle strength in our sample, suggesting management with individualized ICT-based programmes as a safe and effective approach. Considering the increasing number of HF patients with frailty worldwide, our approach provides an efficient method to keep patients engaged in physical activity in their daily life.
心脏康复（CR）是一种基于证据的二级预防策略，可降低心力衰竭（HF）患者的死亡率和发病率。然而，CR 的实施和持续仍然不尽人意，特别是对于身体虚弱的门诊患者。本研究调查了一种综合家庭心脏康复（HBCR）计划的疗效和安全性，该计划结合了使用信息和通信技术（ICT）的患者教育、运动指导和营养指导。
这是一项单中心、开放标签、随机、对照试验。2020 年 4 月至 2020 年 11 月期间，共纳入 30 名患有慢性 HF（纽约心脏协会 II-III 级）和身体虚弱的门诊患者。对照组（n=15）继续接受标准护理，而 HBCR 组（n=15）也接受了全面的个体化 CR，包括使用 Fitbit®设备通过 ICT 进行基于 ICT 的运动和营养指导，为期 3 个月。CR 团队每周通过应用程序消息传递工具与 HBCR 组的每位患者进行一次沟通，并根据每位患者的症状和运动期间记录的脉搏数据，为下周单独计划训练频率和强度。营养师进行营养评估，然后使用应用程序的图片发布功能为每位患者提供个性化营养建议。主要结局是 6 分钟步行距离（6MWD）的变化。参与者的平均年龄为 63.7±10.1 岁，53%为男性，87%患有非缺血性心脏病。在 HBCR 组，6MWD 的观察到的变化明显更大（52.1±43.9 m 比 -4.3±38.8 m；P<0.001），其依从率为 73%。两组均无不良事件的显著变化。
我们使用 ICT 为身体虚弱的 HF 患者实施的综合 HBCR 计划提高了运动耐量，并改善了我们样本的下肢肌肉力量，表明使用基于个体化 ICT 的计划进行管理是一种安全有效的方法。考虑到全球衰弱 HF 患者的数量不断增加，我们的方法为使患者保持日常生活中的身体活动提供了一种有效的方法。
