Abstract 4373203: Basic Tools and Big Impact: A Tele-assisted Home-based Cardiac Rehabilitation Model for LMICs

Abstract

Background: Cardiac rehabilitation (CR) is a widely recommended evidence-based intervention for patients with cardiovascular (CV) diseases; it’s underutilized due to geographical, physical, or psychological barriers. CR is available at only a few centers in the Indian subcontinent and low- and middle-income countries (LMICs), so there is an urgent need to find alternative ways to bridge the barriers and augment the delivery of CR services. The evidence behind home-based CR (HBCR) is relatively new&underdeveloped; its findings are consistent with center-based CR (CBCR). Hypotheses: To study the feasibility, safety, and clinical effectiveness of a home-based tele-CR model in improving functional status, CV risk factors, and quality of life (QoL) in coronary artery disease (CAD) patients. Methods: This single-center, time-bound, randomized controlled, exploratory pilot study included (n=78) patients with CAD (post-acute coronary syndrome and stable CAD) randomized 1:1 to either the Tele-CR group (n=38) or the standard care group (n=40). The Tele CR arm received structured, remotely monitored cardiac rehabilitation, including exercise training, risk factor modification, psychosocial support, and medication adherence counseling (6 sessions of CBCR&22 sessions of HBCR) as per protocol over 24 weeks. Functional status (6-minute walk test), QoL (EQ-5D-5L&MLHFQ), and mental health assessment using the PHQ-9 questionnaire were assessed at baseline, 3 months, and 6 months. Adherence and adverse events were recorded. Results: Out of the (n=108) screened, 73 completed the study (Tele-CR: n=36&standard care: n=37). The Tele-CR group demonstrated significantly greater improvement in 6MWT distance (mean increase 78.6±15.4 m vs. 32.1±10.8 m, p<0.001), QoL scores (EQ-5D-5L index score +0.23 vs. +0.08, p=0.01), and PHQ-9 score (reduction by 5.2 vs. 1.9 points, p<0.01) compared to controls. The CR completion rate was 70%, with participants attending 50% of the CBCR sessions, whereas approximately 89% attended ≥70% of the net-Tele CR sessions. Conclusions: The remote monitoring and real-time supervision using basic tools and mobile phones were cost-effective, feasible, and safe alternatives if participants were trained and educated before initiation. Short-term improvements in functional capacity, health-related QoL, and CVD risk factor control and impact on mortality and hospitalization are similar in HBCR and CBCR.