Conducting cardiac rehabilitation via telemedicine may be an effective alternative to conventional onsite programs in terms of risk reduction a small pilot study shows. The results for both the onsite and remote group of patients mirrored results reported in previous cardiac rehabilitation research.
Led by Lance Dalleck, formerly with the Department of Human Performance, Minnesota State University-Mankato, the researchers believe this study is among the first to use telemedicine to deliver cardiac rehabilitation at a remote site. Earlier studies of telemedicine in cardiac rehabilitation have shown it to be useful for teaching, monitoring and providing support to cardiac patients at a distance
“There were no significant differences in the changes from baseline to post program values between conventional cardiac rehabilitation and telemedicine-delivered cardiac rehabilitation for any of the measured variables,” wrote Dalleck, who is now at the Department of Sport and Exercise Science, University of Auckland, New Zealand. “These findings suggest that telemedicine can be used to deliver cardiac rehabilitation effectively to patients who otherwise would not have access to such programs.”
The purpose of the small feasibility study was to show that cardiac rehabilitation could be done via telemedicine. The researchers compared changes in cardiovascular disease risk factors between telemedicine-delivered cardiac rehabilitation and conventional onsite cardiac rehabilitation. The study was published online April 20, 2011, in the Journal of Telemedicine and Telecare ahead of print publication.
In the study, 236 patients had undergone a variety of cardiac treatments including coronary artery bypass graft surgery (CABG), percutaneous transluminal coronary angioplasty (PTCA) or another transcatheter procedure (e.g. PTCI), myocardial infarction (MI) or valve surgery between January 2006 and December 2009.
Dalleck told the Hub by e-mail that 173 received conventional rehabilitation at the treatment center in Albuquerque, New Mexico, while 53 participants underwent cardiac rehabilitation via telemedicine delivered at a remote location in Gallup, New Mexico 240 km, or 2.5 hours from the conventional cardiac rehabilitation site.
After treatment, an exercise physiologist measured and recorded each patient’s cardiovascular disease risk factors, including resting blood pressure, anthropometric measurements (height and weight), lipid profile, and current physical activity patterns. The exercise physiologist then conducted an exercise test to establish baseline functional capacity.
Patients then met a registered dietitian who reviewed their dietary intake patterns. The dietitian scored dietary and stress questionnaires. Finally, patients met a cardiologist to discuss their medical condition, possible limitations, and to decide risk factor reduction goals such as increase energy expenditure and decrease systolic blood pressure.
Supervised exercise took place each Monday, Wednesday and Friday at both the conventional treatment center and the remote rehabilitation center. Throughout the cardiac rehabilitation program patients were supervised during exercise sessions and monitored via portable telemetry, pulse oximetry, blood pressure and RPE (rating of perceived exertion), which Dalleck said were transmitted via telemedicine to the conventional exercise site, where the data were collected and analyzed.
Each site had two large screen video displays and two videoconferencing units that could be controlled remotely. In addition, each site had one video visualizer camera that could be used to display medical information or educational materials to the patient. One set of equipment was located in the exercise room, while the second set was located in the private room used for consultation. Telecommunication between the locations was via a T-1 connection.
Overall attendance was similar between the two groups with 83 percent regularly attending at the conventional cardiac rehabilitation program and 81 percent attended the telemedicine-based cardiac rehabilitation program. At the end of the program, patients duplicated the procedures of the baseline appointment with the exercise physiologist, registered dietitian and cardiologist.
Results showed that energy expenditure increased significantly from baseline in both conventional and telemedicine delivered groups, and reached an average of 1,181 kcal per week in the conventional site and 1,225 kcal/week at the telemedicine site. The researchers noted that meeting a threshold of 1,000 kcal/week is associated with a 10 percent to 20 percent reduction in coronary heart disease event rate.
HDL-cholesterol levels for the conventional group and the telemedicine group both increased by 4.1 mg/dL from baseline to post program measurements. Triglyceride levels decreased significantly in the conventional group by 22 mg/dL but not in the telemedicine group, with an average decline in triglycerides of 8 mg/dL.
There was no significant change from baseline in systolic blood pressure values at either site, however, there was a significant improvement in the diastolic blood pressure at the conventional site, but not the telemedicine site.
Likewise, there were no significant change from baseline fat or triglyceride values at the telemedicine delivered site, while there was a significant improvement in fat and triglyceride values at the conventional rehabilitation site.
In reverse, there was a significant improvement in the average BMI at the telemedicine site but not at the conventional site. Both sites saw significant improvements in energy expenditure, stress, total cholesterol, HDL and LDL cholesterol from baseline.
The researchers note that the current study was limited by size and by use of a convenience sample in which participants were assigned to their respective groups based on location, rather than randomly assigned.
Dalleck said he is pursuing funding for a larger study in New Zealand. “I do indeed hope to expand our previous work to a larger, randomized controlled trial in this country where heart disease accounts for 44 percent of all deaths,” Dalleck said. “Presently we have a few rural sites in mind and are working on funding for a PhD student to assist with the project.”
By Michael O’Leary, contributing writer, Health Imaging Hub