EU-CaRE study: Could exercise-based cardiac telerehabilitation also be cost-effective in elderly?
Introduction
The role of cardiac rehabilitation (CR) is well established in the secondary prevention of ischemic heart disease (IHD) [[1], [2], [3], [4]]. Multiple studies have demonstrated the effectiveness and cost-effectiveness of CR in reducing morbidity and mortality along with increasing quality of life (QoL) and psychological well-being [[1], [2], [3], [4]]. Unfortunately, the latest EUROASPIRE survey revealed that still only few of the eligible IHD patients participate in phase II CR [5]. Multiple reasons are stated for the low participation rates such as lower health literacy or transport, familial, vocational, and schedule constraints [6,7]. The participation rates are even worse for elderly patients, despite their higher prevalence of comorbidities and a less physically active lifestyle [8]. Therefore, home-based mobile CR programmes have been researched as an alternative. However, many fear that this will leave out elderly who are often less digitally literate. Telerehabilitation or mobile CR programme is defined as the use of digital tools to deliver the core components of CR from a distance. It allows remote monitoring of patients and the provision of objective feedback to those patients who are unable or not willing to participate in centre-based CR programmes. Numerous studies have demonstrated that mobile CR programmes are as effective as centre-based CR in terms of exercise capacity and QoL [[9], [10], [11], [12]]. A recent systematic review concluded that, based on small and short duration trials, the mobile CR programme seems to be as cost-effective as centre-based CR programmes [13]. The EU-CaRE RCT researched the effectiveness of a mobile CR programme in elderly patients that were not willing to participate in center-based CR [14]. Snoek et al. revealed that a 6-month home-based mobile CR programme focusing on exercise was safe and beneficial in improving VO2peak when compared with no CR [14]. With this EU-CaRE RCT follow-up study, we assessed whether the 6-month home-based mobile CR programme was cost-efficient in comparison with no CR.
Section snippets
Study design
The European study on effectiveness and sustainability of current CR programmes in the Elderly (EU-CaRE) is an international multicentre parallel RCT. The study was conducted in accordance with the applicable legislation and guidelines. Six European cardiac institutions across five European countries participated in the EU-CaRE RCT: Isala Heart Centre (The Netherlands), Bispebjerg University Hospital, Copenhagen, Denmark (Denmark), Assistance Publique – Hôpitaux de Paris (France), Bern
Baseline characteristics
In total, 162 patients were included in the analysis. The data of 17 patients that were lost in follow-up were excluded from this analysis. Only 26% of eligible patients who declined centre-based CR participated decided to take part in the present study.
The patients in the intervention group (n = 79) had a mean age of 72.3 years and were predominantly men (85.5%). The patients in the control group (n = 83) had a mean age of 73.3 years and were predominantly men (78.5%). Only the presence of
Discussion
In elderly cardiac patients not willing to participate in a regular rehabilitation programme, the mobile CR programme was effective in improving VO2peak between both baseline and the end of the 6-month mobile CR programme and between baseline and the end of the follow-up after 12 months at reasonably low cost. The intervention was more cost-effective in patients who were adherent to the mobile CR programme.
The costs of care utilisation showed a non-significant decrease in the intervention group
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: this work was funded by the European Union's Horizon 2020 research and innovation programme under grant agreement No 634439. For the Swiss consortium partner, funding was received by the Swiss State Secretariat for Education, Research and Innovation under contract number 15.0139. TM, PE and MW report grants from State Secretariat for Education, Research and
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