A Mobile rehabilitation application for the remote monitoring of cardiac patients after a heart attack or a coronary bypass surgery

This paper describes a personalised rehabilitation application using a smart phone (PDA) and wireless (bio) sensors. It instructs and motivates patients to follow their exercise programme and keeps track of their progress. It also monitors the relevant biosignals and provides immediate feedback to the patient. Sensors transmit data to the mobile phone where it is analysed locally and the data can also be instantaneously transmitted to a healthcare centre for remote monitoring by a health professional. The rehabilitation application is personalised for each cardiac patient and provides tailored advice (e.g. exercise more, slow down). A trial with a rehabilitation centre is in progress in which we investigate whether the personalised rehabilitation application improves the success of the rehabilitation programme in terms of patient compliance with recommended life style changes (such as increase physical activity or lose weight) and whether use of the system brings peace of mind to cardiac patients. Copyright 2009 ACM

Personalised mobile services supporting the implementation of clinical guidelines

Telemonitoring is emerging as a compelling application of Body Area Networks (BANs). We describe two health BAN systems developed respectively by a European team and an Australian team and discuss some issues encountered relating to formalization of clinical knowledge to support real-time analysis and interpretation of BAN data. Our example application is an evidence-based telemonitoring and teletreatment application for home-based rehabilitation. The application is intended to support implementation of a clinical guideline for cardiac rehabilitation following myocardial infarction. In addition to this the proposal is to establish the patient’s individual baseline risk profile and, by real-time analysis of BAN data, continually re-assess the current risk level in order to give timely personalised feedback. Static and dynamic risk factors are derived from literature. Many sources express evidence probabilistically, suggesting a requirement for reasoning with uncertainty; elsewhere evidence requires qualitative reasoning: both familiar modes of reasoning in KBSs. However even at this knowledge acquisition stage some issues arise concerning how best to apply the clinical evidence. Furthermore, in cases where insufficient clinical evidence is currently available, telemonitoring can yield large collections of clinical data with the potential for data mining in order to furnish more statistically powerful and accurate clinical evidence

Examining adherence to activity monitoring devices to improve physical activity in adults with cardiovascular disease: A systematic review

Background Activity monitoring devices are currently being used to facilitate and monitor physical activity. No prior review has examined adherence to the use of activity monitoring devices amongst adults with cardiovascular disease. Methods Literature from June 2012 to October 2017 was evaluated to examine the extent of adherence to any activity monitoring device used to collect objective physical activity data. Randomized control trials comparing usual care against the use of an activity monitoring device, in a community intervention for adults from any cardiovascular diagnostic group, were included. A systematic search of databases and clinical trials registers was conducted using Joanna Briggs Institute methodology. Results Of 10 eligible studies, two studies reported pedometer use and eight accelerometer use. Six studies addressed the primary outcome. Mean adherence was 59.1% (range 39.6% to 85.7%) at last follow-up. Studies lacked equal representation by gender (28.6% female) and age (range 42 to 82 years). Conclusion This review indicates that current research on activity monitoring devices may be overstated due to the variability in adherence. Results showed that physical activity tracking in women and in young adults have been understudied

Feasibility trial of a novel mobile cardiac rehabilitation application

A trial with a cardiac rehabilitation centre is in progress where we test a novel cardiac rehab application using a standard mobile phone and wireless sensors. The goal is to obtain insight how remote monitoring compares to conventional rehabilitation methods in terms of adherence to cardiac rehabilitation programmes. In this trial we seek feedback from patients and health professionals regarding usability and practicability of the software and hardware used and we investigate whether the use of the novel mobile rehabilitation application provides clinically meaningful reassurance to patients during their cardiac rehabilitation. The trial also investigates whether physical and psychological measures improve using the system. This paper describes the mobile cardiac rehabilitation application as well as the setup of the trial. © 2010 IEEE

Home-based versus centre-based cardiac rehabilitation (Review)

This is the final version. Available from the Cochrane Collaboration via the DOI in this recordBACKGROUND: Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017. OBJECTIVES: To compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA: We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. MAIN RESULTS: We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar. AUTHORS' CONCLUSIONS: This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.National Institute for Health and Care Research (NIHR

Circ Cardiovasc Qual Outcomes

This article describes the October 2020 proceedings of the Million Hearts Cardiac Rehabilitation Think Tank: Accelerating New Care Models, convened with representatives from professional organizations, cardiac rehabilitation (CR) programs, academic institutions, federal agencies, payers, and patient representative groups. As CR delivery evolves, terminology is evolving to reflect not where activities occur (eg, center, home) but how CR is delivered: in-person synchronous, synchronous with real-time audiovisual communication (virtual), or asynchronous (remote). Patients and CR staff may interact through 651 delivery modes. Though new models may change how CR is delivered and who can access CR, new models should not change what is delivered-a multidisciplinary program addressing CR core components. During the coronavirus disease 2019 (COVID-19) public health emergency, Medicare issued waivers to allow virtual CR; it is unclear whether these waivers will become permanent policy post-public health emergency. Given CR underuse and disparities in delivery, new models must equitably address patient and health system contributors to disparities. Strategies for implementing new CR care models address safety, exercise prescription, monitoring, and education. The available evidence supports the efficacy and safety of new CR care models. Still, additional research should study diverse populations, impact on patient-centered outcomes, effect on long-term outcomes and health care utilization, and implementation in diverse settings. CR is evolving to include in-person synchronous, virtual, and remote modes of delivery; there is significant enthusiasm for implementing new care models and learning how new care models can broaden access to CR, improve patient outcomes, and address health inequities.CC999999/ImCDC/Intramural CDC HHSUnited States

Context-aware system for cardiac condition monitoring and management: a survey

Health monitoring assists physicians in the decision-making process, which in turn, improves quality of life. As technology advances, the usage and applications of context-aware systems continue to spread across different areas in patient monitoring and disease management. It provides a platform for healthcare professionals to assess the health status of patients in their care using multiple relevant parameters. In this survey, we consider context-aware systems proposed by researchers for health monitoring and management. More specifically, we investigate different technologies and techniques used for cardiac condition monitoring and management. This paper also propose "mCardiac", an enhanced context-aware decision support system for cardiac condition monitoring and management during rehabilitation

Context-aware approach for cardiac rehabilitation monitoring

As technology advances, the usage and applications of context-aware systems continue to spread across different areas in patient monitoring and disease management. It provides a platform for healthcare professionals to assess the health status of patients in their care using multiple relevant parameters. Existing technologies for cardiac patient monitoring are generally based on the physiological information, mostly the heart rate or Electrocardiogram(ECG) Signals. Other important factors such as physical activities and time of the day are usually ignored. We propose a context-aware solution for cardiac rehabilitation monitoring using multiple vital signs from the physiological and activity data of the patient. This research considers the activity of the patient alongside the time of the activity to facilitate physicians decision-making process. We provide a personalised physical activity recognition processing by generating a personalised model for each user. A prototype is presented to illustrate our proposed approach

Cardiac Telehealth Rehabilitation: Empowering the Patient

Coronary artery disease or coronary heart disease is one of the leading causes of death in the world. Center-based cardiac rehab has long been a sustainable answer for recovery from an acute coronary event. However, the COVID-19 pandemic halted in-person appointments for cardiac rehab patients. Therefore, patients and their healthcare team met virtually. The objective of this literature review is to discover the efficacy and cost-effectiveness of cardiac telerehabilitation, as it will likely have a more prominent role in patient recovery from acute myocardial infarctions. To determine this, a literature review was conducted based on recent studies involving coronary artery disease patients in a center-based cardiac rehab and telehealth style cardiac rehab. Twenty-one articles were reviewed, and five themes were revealed. These include lifestyle modifications, secondary prevention, patient-led care and adherence, technology during COVID-19, and cost-effectiveness. From these themes, a concept map was constructed. The literature revealed no statistically significant difference in patient outcomes between telehealth-based and center-based cardiac rehab. Telehealth rehab also demonstrated cost-effectiveness in various delivery methods including telephone, short messaging services, mobile applications, and video calls. Therefore, it can be concluded that cardiac telehealth rehab can be offered as a primary option for cardiac rehab. With the common barriers to attending in person cardiac rehab including schedule, geographical barriers, and the COVID-19 pandemic, telehealth rehab offers the patient relief of some of these barriers