‘More accessible’ hybrid cardiac rehab program yields outcomes similar to in-person visits
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Key takeaways:
- A hybrid cardiac rehab model combining in-person sessions with phone and text support was as effective as fully in-person sessions.
- The model could be useful for patients living in low-resource communities.
Adults referred to cardiac rehabilitation derived similar benefits regardless of whether they attended in-person sessions or a hybrid program with phone calls and text messages to support home rehab, researchers reported.
“The HYCARET study showed that a hybrid cardiac rehabilitation program — with a center-based component and a home-based component with remote follow-up via text messages and phone calls — is not inferior in effectiveness to a regular center-based rehabilitation program, in terms of recurrent CV events and other functional and patient-reported outcomes,” Pamela Seron, PhD, a physical therapist in preventive medicine and full professor in the rehabilitation sciences department at University of La Frontera in Temuco, Chile, told Healio. “This leaves a more accessible program available to patients and health services while ... improving coverage by reducing face-to-face care times.”
Image: Adobe Stock
In an open-label randomized controlled trial, Seron and colleagues analyzed data from 191 adults who had a CV event or procedure and no contraindications to exercise from six referral centers in Chile assigned to hybrid cardiac rehab (n = 93) or standard in-person cardiac rehab (n = 98). The patients (mean age, 59 years; 76% men) were recruited from April 2019 to March 2020 and followed through July 2021. Recruitment was suspended due to the COVID-19 pandemic.
Patients assigned to the hybrid arm attended 10 center-based supervised exercise sessions plus counseling over 4 to 6 weeks and then were supported at home via phone calls and text messages through weeks 8 to 12. Patients in the control arm received standard cardiac rehab, consisting of 18 to 22 sessions with exercises and education over 8 to 12 weeks. The primary outcome was CV events or mortality. Secondary outcomes included quality of life measures, return to work and lifestyle behaviors measured via questionnaires, as well as muscle strength and functional capacity measured via physical tests. The researchers also assessed program adherence and exercise-related adverse events.
The findings were published in JAMA Network Open.
At 1 year, 5.38% of participants in the hybrid cardiac rehab group and 9.18% of participants in the standard cardiac rehab group experienced CV events.
In the intention-to-treat analysis, the hybrid cardiac rehab group had 3.8% fewer CV events than controls, with a RR of 0.59 for noninferiority (95% CI, 0.2-1.68).
“The per-protocol analysis showed that all point estimates did not exceed the noninferiority threshold but the upper limits of the 95% CIs exceeded the threshold, indicating that, in some patients, the hybrid cardiac rehab was inferior to the standard cardiac rehab,” the researchers wrote.
The researchers noted that per-protocol analyses exclude participants who do not adhere to treatment; in this trial, adherence differed significantly by trial arm, raising the possibility of exclusion bias.
In assessing secondary outcomes, the researchers only observed a between-group difference for adherence to supervised cardiac rehab, with 79.14% attendance in the hybrid group vs. 61.46% in the control group (P < .001).
“This is relevant, especially in low- and middle-income settings with limited cardiac rehabilitation coverage,” Seron told Healio. “In the future, whether this rehabilitation model is feasible to be used in different settings in low-resource contexts and to explore patients’ preferences and perceptions should be tested.”
For more information:
Pamela Seron, PhD, can be reached at pamela.seron@ufrontera.cl; X (Twitter): @pame_seron.
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