Remotely monitored telerehabilitation for cardiac patients: A review of the current situation

Cardiac rehabilitation through center-based programs is an effective multicomponent intervention for the secondary prevention of cardiovascular diseases.Despite the benefits it brings,patients’participation in rehabilitation programs remains low.In this work,the latest relevant literature regarding remotely monitored cardiac telerehabilitation(TR)was reviewed considering its efficiency and utilization.The main objective was to assess whether TR has the potential to be an appropriate alternative form of rehabilitation.A total of 105 publications on this topic were screened out of 747 full-text articles that were read and evaluated,of which 12 were considered suitable for inclusion in the final review.Feasibility,efficiency,and safety were assessed for each TR intervention.The results of our evaluation indicate that TR seems to be a usable,effective,and safe alternative rehabilitation for patients with heart disease.Most of the currently published articles have studied remotely monitored TR intervention offering a comprehensive approach,which indicates the significant development and steps forward in this field of study.Our research evidence supports the implementation of TR,which could positively influence barriers in participating in cardiac rehabilitation programs.

Effect of a cardiac telerehabilitation program during COVID-19 associated social isolation

This study aimed to compare the impact of a cardiac telerehabilitation(CTR)protocol aimed at patients with cardiovascular diseases(CVDs)during the period of coronavirus disease 2019(COVID-19)associated with social isolation.This retrospective cohort study included 58 participants diagnosed with stable cardiovascular diseases(CVDs),which were divided into three groups:conventional cardiac rehabilitation(CCR)group(n=20),composed of patients undergoing conventional cardiac rehabilitation;cardiac telerehabilitation(CTR)group(n=18),composed of patients undergoing cardiac telerehabilitation and control group(n=20),composed of patients admitted for cardiac rehabilitation who had not started training programs.The results showed that body mass index was reduced(p=0.019)and quality of life was improved(e.g.,limitations due to physical aspects[p=0.021),vitality[p=0.045]and limitations due to emotional aspects[p=0.024])by CCR compared to baseline.These outcomes were not improved by CTR(p>0.05).However,this strategy prevented clinical deterioration in the investigated patients.Although CCR achieved a superior effect on clinical improvement and quality of life,CTR was relevant to stabilize the blood pressure and quality of life of patients with cardiovascular diseases during the period of COVID-19-associated social isolation.

Cardiac rehabilitation and its essential role in the secondary prevention of cardiovascular diseases

Cardiovascular diseases are the most common causes of mortality worldwide.They are frequently the reasons for patient hospitalization,their incapability for work,and disability.These diseases represent a significant socio-economic burden affecting the medical system as well as patients and their families.It has been demonstrated that the etiopathogenesis of cardiovascular diseases is significantly affected by lifestyle,and so modification of the latter is an essential component of both primary and secondary prevention.Cardiac rehabilitation(CR)represents an efficient secondary prevention model that is especially based on the positive effect of regular physical activity.This review presents an overview of basic information on CR with a focus on current trends,such as the issue of the various training modalities,utilization,and barriers to it or the use of telemedicine technologies.Appropriate attention should be devoted to these domains,as CR continues evolving as an effective and readily available intervention in the future.

家庭远程心脏康复对冠心病患者临床结局影响的Meta分析

目的 探讨家庭远程心脏康复(HBCTR)在冠心病患者中的应用效果。方法 系统检索Cochrane Library、Web of Science、PubMed、Embase、CINAHL、中国知网、万方、维普和SinoMed数据库建库至2022年1月1日关于HBCTR对冠心病患者干预效果的随机对照试验。对文献进行筛选、资料提取及质量评价后,采用RevMan 5.3软件对数据进行Meta分析。结果 共纳入13篇RCT,涉及2 742例患者。Meta分析结果显示:HBCTR可有效提升冠心病患者的左心室射血分数[MD=2.99,95%CI(1.21,4.76),P=0.001]、峰值摄氧量[MD=2.19,95%CI(0.80,3.58),P<0.01]、6 min步行距离[MD=29.21,95%CI(11.48,46.94),P<0.01]与生活质量[SMD=0.32,95%CI(0.16,0.47),P<0.01](生理功能)、[SMD=0.24,95%CI(0.08,0.39),P<0.01](心理功能)。但在改善患者BMI[MD=0.29,95%CI(-0.17,0.75),P=0.22]、收缩压[MD=-0.88,95%CI(-3.93,2.17),P=0.26]、舒张压[MD=-0.44,95%CI(-1.21,0.33),P=0.23]、焦虑[SMD=-0.13,95%CI(-0.30,0.04),P=0.13]及抑郁[SMD=-0.13,95%CI(-0.29,0.02),P=0.10]方面,差异无统计学意义。结论 HBCTR可有效改善冠心病患者的心功能、运动耐力与生活质量,但在血压、BMI及负性情绪等方面的作用尚需开展进一步的研究予以验证。

女性心血管疾病患者心脏康复的研究进展

心脏康复作为目前女性心血管患者治疗指南的ⅠA类二级预防项目,以安全、个性化、结构化的运动康复为基础,辅以心理咨询、家庭教育、健康行为的建立以及疾病危险因素的控制,其核心组成部分包括病人评估、风险因素修正、压力管理和心理状况审查。既往研究显示女性患者入组困难,且具有较高的失访率,致使此类研究中普遍存在选择性偏移。女性心脏康复,是指内容适应女性需求和偏好的心脏康复。本研究对女性心血管疾病患者心脏康复的研究进展进行综述。

心血管疾病患者远程心脏康复体验质性研究的Meta整合

目的系统评价心血管疾病(CVD)患者远程心脏康复体验的质性研究,为临床开展及改善远程心脏康复服务提供参考依据。方法计算机检索PubMed、Web of Science、Embase、CINAHL、Cochrane Library、Scopus、中国知网、中国生物医学文献数据库、万方数据库、维普网中关于CVD患者远程心脏康复体验的质性研究,检索时限为建库至2023年8月。根据澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准对文献进行质量评价,运用汇集性整合法对研究结果进行整合。结果共纳入13篇文献,提炼出52个研究结果,归纳为11个类别,综合形成CVD患者参与远程心脏康复的益处、CVD患者参与远程心脏康复的促进因素、CVD患者参与远程心脏康复的障碍因素,以及CVD患者对远程心脏康复的期望与建议4个整合结果。结论 CVD患者参与远程心脏康复获益明显,未来应进一步关注影响患者参与远程心脏康复的因素,依据患者需求和建议,积极研发适用于国内的远程心脏康复工具,优化远程康复模式。

家庭远程心脏康复在老年心力衰竭患者中应用的范围综述

目的基于范围综述框架,回顾和分析家庭远程心脏康复(HBCTR)在老年心力衰竭(HF)患者中应用的相关研究。方法通过查阅文献明确研究问题后,检索PubMed、Embase、Cochrane Library、CINAHL、Web of Science、Scopus、ProQuest、PsycINFO、中国知网、万方数据知识服务平台、维普网和中国生物医学文献数据库中关于HBCTR在老年HF患者中应用的研究,同时补充检索相关研究的参考文献,检索时限为建库至2023-11-09。将检索获得的文献导入EndNoteX9软件进行管理,查找重复文献并剔除。由2名研究人员独立进行文献筛选与资料提取。结果最终纳入文献13篇,共有2727例老年HF患者。HBCTR主要包括3种模式,分别为虚拟心脏康复(CR)模式、远程CR模式、混合CR模式;HBCTR的干预内容包括5个方面,分别为运动训练、饮食管理、心理支持、药物管理、危险因素管理;HBCTR的技术形式包括5种,分别为社交媒体、电话随访、可穿戴设备、远程康复系统、网络信息化平台。HBCTR可有效降低老年HF患者的明尼苏达心力衰竭生活质量量表(MLHFQ)评分、脑钠肽(BNP)、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分、再住院率,升高左心室射血分数(LVEF)、峰值摄氧量(VO_(2peak)),延长6 min步行距离(6MWD)。结论HBCTR主要包括3种模式(虚拟CR模式、远程CR模式和混合CR模式)、5个方面的干预内容(运动训练、饮食管理、心理支持、药物管理和危险因素管理)、5种技术形式(社交媒体、电话随访、可穿戴设备、远程康复系统和网络信息化平台),其能够有效提高老年HF患者的生活质量和功能能力,改善心功能、心理状况,降低再住院率。然而目前HBCTR在老年HF患者中的应用尚不成熟,其内容和服务模式有待进一步完善,同时需要重点关注老年群体的疾病复杂性和特殊性。

家庭远程心脏康复发展历程、模式及干预效果

随着我国社会经济的发展和人口老龄化程度的加剧,心血管疾病的发病率和死亡率持续攀升,而心脏康复能够降低其死亡率和再入院率,提高患者的健康相关生活质量。家庭远程心脏康复具有便利、个性化和花费低的特点,能够提高患者的依从性和参与度,可作为中心心脏康复的有效替代方案。本文对家庭远程心脏康复的发展历程、模式、干预效果及不足进行综述,以期为推动我国家庭远程心脏康复的发展提供参考。

远程心脏康复对慢性心力衰竭患者影响的Meta分析

目的:系统评价远程心脏康复(CR)对慢性心力衰竭(CHF)患者的影响。方法:计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网(CNKI)、中国生物医学文献数据库、万方数据知识服务平台、维普中文科技期刊数据库(VIP),收集远程CR应用于CHF患者的随机对照试验相关文献,检索时限为建库至2022年4月。对符合纳入、排除标准的文献进行质量评价,使用RevMan 5.3软件对提取数据进行Meta分析。结果:最终纳入20篇文献,共2670例患者。Meta分析结果显示,与传统康复护理相比,远程CR能有效地提高CHF患者心肺功能(MD=31.58,95%CI:10.5~52.67,P=0.003)、运动功能(MD=38.59,95%CI:22.73~54.46,P<0.05)、VO_(2)峰值(MD=2.72,95%CI:0.62~4.82,P=0.01)、生活质量(MD=-10.24,95%CI:-13.51~-6.97,P<0.0001)、CR依从性(RR=2.51,95%CI:1.58~3.99,P<0.0001);在缓解焦虑(MD=-0.30,95%CI:-0.61~0.02,P>0.05)和抑郁方面(MD=-0.19,95%CI:-0.52~0.15,P>0.05)两者差异无统计学意义。结论:远程CR与传统康复护理相比,能有效地改善CHF患者的心肺功能和运动能力,提升其生活质量和CR依从性,但在改善心理健康方面缺乏证据支持。需要进一步的研究验证远程CR对CHF患者的有效性、安全性和成本效益。

远程心脏康复有效性及依从性的系统评价再评价

目的对远程心脏康复的有效性及依从性进行系统评价再评价。方法计算机检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、澳大利亚乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健中心数据库、British Medical Journal最佳临床实践、Cochrane Library、PubMed、Embase、CINAHL数据库以及PROSPERO注册平台有关远程心脏康复的系统评价,检索时限为2012年2月—2022年10月,由2名研究者独立完成纳入文献的质量评价、资料提取。结果共纳入14篇系统评价,其中2篇质量等级为中,6篇质量等级为低,6篇质量为极低。重新Meta分析结果显示,应用通信技术、智能手机应用程序、可穿戴设备等的远程辅助措施可有效改善患者心肺功能、运动能力和生活质量等,但虚拟现实技术效果有待进一步验证。结论远程辅助可以提高心脏康复的有效性及依从性,但系统评价的方法学和证据的质量均较低,且多基于国外研究,证据应用时需进行本土化调试,并开展符合中国国情的高质量研究。

远程心脏康复应用现状与效果分析

本文从远程心脏康复的产生、需求度与可行性、应用现状与效果等方面综述了远程心脏康复的应用情况,为我国开展远程心脏康复提供依据。