Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial

Ralph Maddison; Jonathan Charles Rawstorn; Ralph A H Stewart; Jocelyne Benatar; Robyn Whittaker; Anna Rolleston; Yannan Jiang; Lan Gao; Marj Moodie; Ian Warren; Andrew Meads; Nicholas Gant

doi:10.1136/heartjnl-2018-313189

Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial

Heart. 2019 Jan;105(2):122-129. doi: 10.1136/heartjnl-2018-313189. Epub 2018 Aug 27.

Authors

Ralph Maddison^{1

2}, Jonathan Charles Rawstorn^{1

2}, Ralph A H Stewart³, Jocelyne Benatar³, Robyn Whittaker², Anna Rolleston⁴, Yannan Jiang², Lan Gao⁵, Marj Moodie⁵, Ian Warren⁶, Andrew Meads⁶, Nicholas Gant⁷

Affiliations

¹ Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia.
² National Institute for Health Innovation, University of Auckland, Auckland, New Zealand.
³ Department of Cardiology, Auckland City Hospital, Auckland, New Zealand.
⁴ The Centre for Health, Tauranga, New Zealand.
⁵ Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia.
⁶ Department of Computer Science, University of Auckland, Auckland, New Zealand.
⁷ Department of Exercise Sciences, University of Auckland, Auckland, New Zealand.

Abstract

Objective: Compare the effects and costs of remotely monitored exercise-based cardiac telerehabilitation (REMOTE-CR) with centre-based programmes (CBexCR) in adults with coronary heart disease (CHD).

Methods: Participants were randomised to receive 12 weeks of telerehabilitation or centre-based rehabilitation. REMOTE-CR provided individualised exercise prescription, real-time exercise monitoring/coaching and theory-based behavioural strategies via a bespoke telerehabilitation platform; CBexCR provided individualised exercise prescription and coaching via established rehabilitation clinics. Outcomes assessed at baseline, 12 and/or 24 weeks included maximal oxygen uptake (V̇O₂max, primary) modifiable cardiovascular risk factors, exercise adherence, motivation, health-related quality of life and programme delivery, hospital service utilisation and medication costs. The primary hypothesis was a non-inferior between-group difference in V̇O₂max at 12 weeks (inferiority margin=-1.25 mL/kg/min); inferiority margins were not set for secondary outcomes.

Results: 162 participants (mean 61±12.7 years, 86% men) were randomised. V̇O₂ max was comparable in both groups at 12 weeks and REMOTE-CR was non-inferior to CBexCR (REMOTE-CR-CBexCR adjusted mean difference (AMD)=0.51 (95% CI -0.97 to 1.98) mL/kg/min, p=0.48). REMOTE-CR participants were less sedentary at 24 weeks (AMD=-61.5 (95% CI -117.8 to -5.3) min/day, p=0.03), while CBexCR participants had smaller waist (AMD=1.71 (95% CI 0.09 to 3.34) cm, p=0.04) and hip circumferences (AMD=1.16 (95% CI 0.06 to 2.27) cm, p=0.04) at 12 weeks. No other between-group differences were detected. Per capita programme delivery (NZD1130/GBP573 vs NZD3466/GBP1758) and medication costs (NZD331/GBP168 vs NZD605/GBP307, p=0.02) were lower for REMOTE-CR. Hospital service utilisation costs were not statistically significantly different (NZD3459/GBP1754 vs NZD5464/GBP2771, p=0.20).

Conclusion: REMOTE-CR is an effective, cost-efficient alternative delivery model that could-as a complement to existing services-improve overall utilisation rates by increasing reach and satisfying unique participant preferences.

Keywords: cardiac rehabilitation; coronary artery disease; ehealth/telemedicine/mobile health.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Coronary Disease / economics
Coronary Disease / rehabilitation*
Cost-Benefit Analysis
Exercise Therapy / economics
Exercise Therapy / methods*
Female
Humans
Internet*
Male
Middle Aged
New Zealand
Quality of Life*
Rehabilitation Centers*
Telemedicine / methods*
Treatment Outcome

Associated data

ANZCTR/ACTRN12614000843651