DOI QR코드

DOI QR Code

Remote Cardiac Rehabilitation With Wearable Devices

  • Atsuko Nakayama (Department of Cardiology, Sakakibara Heart Institute) ;
  • Noriko Ishii (Department of Nursing, Sakakibara Heart Institute) ;
  • Mami Mantani (Department of Nursing, Sakakibara Heart Institute) ;
  • Kazumi Samukawa (Department of Nursing, Sakakibara Heart Institute) ;
  • Rieko Tsuneta (Department of Nursing, Sakakibara Heart Institute) ;
  • Megumi Marukawa (Department of Nutrition, Sakakibara Heart Institute) ;
  • Kayoko Ohno (Department of Nutrition, Sakakibara Heart Institute) ;
  • Azusa Yoshida (Department of Psychology, Sakakibara Heart Institute) ;
  • Emiko Hasegawa (Department of Psychology, Sakakibara Heart Institute) ;
  • Junko Sakamoto (Department of Rehabilitation, Sakakibara Heart Institute) ;
  • Kentaro Hori (Department of Rehabilitation, Sakakibara Heart Institute) ;
  • Shinya Takahashi (Department of Cardiology, National Hospital Organization Takasaki General Medical Center) ;
  • Kaoruko Komuro (Department of Cardiology, Sakakibara Heart Institute) ;
  • Takashi Hiruma (Department of Cardiology, Sakakibara Heart Institute) ;
  • Ryo Abe (Department of Cardiology, Sakakibara Heart Institute) ;
  • Togo Norimatsu (Department of Cardiology, Sakakibara Heart Institute) ;
  • Mai Shimbo (Department of Cardiology, Sakakibara Heart Institute) ;
  • Miyu Tajima (Department of Cardiology, Sakakibara Heart Institute) ;
  • Mika Nagasaki (Department of Cardiology, Sakakibara Heart Institute) ;
  • Takuya Kawahara (Clinical Research Promotion Center, The University of Tokyo Hospital) ;
  • Mamoru Nanasato (Department of Cardiology, Sakakibara Heart Institute) ;
  • Toshimi Ikemage (Department of Nursing, Sakakibara Heart Institute) ;
  • Mitsuaki Isobe (Sakakibara Heart Institute)
  • 투고 : 2023.08.26
  • 심사 : 2023.09.24
  • 발행 : 2023.11.01

초록

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients' busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as cost-effectiveness and insurance coverage still persist.

키워드

과제정보

The authors acknowledge the members of the CR center in Sakakibara Heart Institute. The authors express their heartfelt gratitude to the members of the remote CR office, Natsumi Hara and Kasumi Ebata, for the administrative work in Sakakibara Heart Institute.

참고문헌

  1. Goto Y. Current state of CR in Japan. Prog Cardiovasc Dis 2014;56:557-62.
  2. Nakayama A, Nagayama M, Morita H, Kawahara T, Komuro I, Isobe M. The use of geographical analysis in assessing the impact of patients' home addresses on their participation in outpatient CR: a prospective cohort study. Environ Health Prev Med 2020;25:76.
  3. De Vos C, Li X, Van Vlaenderen I, et al. Participating or not in a CR programme: factors influencing a patient's decision. Eur J Prev Cardiol 2013;20:341-8.
  4. Ghisi GL, Kin SM, Price J, et al. Women-focused cardiovascular rehabilitation: an International Council of Cardiovascular Prevention and Rehabilitation clinical practice guideline. Can J Cardiol 2022;38:1786-98.
  5. Ministry of Health, Labour and Welfare (JP). Overview of the 2021 medical facilities (dynamic) survey and hospital report [Internet]. Tokyo: Ministry of Health, Labour and Welfare; 2022 [cited 2023 October 12]. Available from: https://www.mhlw.go.jp/toukei/saikin/hw/iryosd/21/index.html. 
  6. Japanese Circulation Society. Report by the Japanese Registry Of All cardiac and vascular Diseases (JROAD) in 2021 [Internet]. Tokyo: Japanese Circulation Society; 2021 [cited 2023 October 12]. Available from: https://www.j-circ.or.jp/jittai_chosa/media/jittai_chosa2020web_1.pdf. 
  7. Kida K, Nishitani-Yokoyama M, Oishi S, et al. Japanese Association of CR (JACR) public relations committee. nationwide survey of Japanese CR training facilities during the coronavirus disease 2019 outbreak. Circ Rep. 2021;3:311-5.
  8. O'Doherty AF, Humphreys H, Dawkes S, et al. How has technology been used to deliver CR during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR. BMJ Open 2021;11:e046051.
  9. Rawstorn JC, Gant N, Direito A, Beckmann C, Maddison R. Telehealth exercise-based CR: a systematic review and meta-analysis. Heart 2016;102:1183-92.
  10. Cleland JG, Louis AA, Rigby AS, Janssens U, Balk AH. TEN-HMS Investigators. Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. J Am Coll Cardiol 2005;45:1654-64.
  11. Ong MK, Romano PS, Edgington S, et al. Effectiveness of remote patient monitoring after discharge of hospitalized patients with heart failure: the Better Effectiveness After Transition -- Heart Failure (BEAT-HF) randomized clinical trial. JAMA Intern Med 2016;176:310-8.
  12. Koehler F, Koehler K, Deckwart O, et al. Efficacy of Telemedical Interventional Management in Patients with Heart Failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Lancet 2018;392:1047-57.
  13. Liu H, Wilton SB, Southern DA, et al. Automated referral to CR after coronary artery bypass grafting is associated with modest improvement in program completion. Can J Cardiol 2019;35:1491-8.
  14. Cavalheiro AH, Silva Cardoso J, Rocha A, Moreira E, Azevedo LF. Effectiveness of telerehabilitation programs in heart failure: a systematic review and meta-analysis. Health Serv Insights 2021;14:11786329211021668.
  15. Nakayama A, Takayama N, Kobayashi M, et al. Remote CR is a good alternative of outpatient CR in the COVID-19 era. Environ Health Prev Med 2020;25:48.
  16. Keteyian SJ, Ades PA, Beatty AL, et al. A review of the design and implementation of a hybrid CR program: an expanding opportunity for optimizing cardiovascular care. J Cardiopulm Rehabil Prev 2022;42:1-9.
  17. Kikuchi A, Taniguchi T, Nakamoto K, et al. Feasibility of home-based CR using an integrated telerehabilitation platform in elderly patients with heart failure: a pilot study. J Cardiol 2021;78:66-71.
  18. Nagatomi Y, Ide T, Higuchi T, et al. Home-based CR using information and communication technology for heart failure patients with frailty. ESC Heart Fail. 2022;9:2407-18.
  19. Kuwabara M, Harada K, Hishiki Y, Kario K. Validation of two watch-type wearable blood pressure monitors according to the ANSI/AAMI/ISO81060-2:2013 guidelines: Omron HEM-6410T-ZM and HEM-6410T-ZL. J Clin Hypertens (Greenwich) 2019;21:853-8.
  20. Mukkamala R, Yavarimanesh M, Natarajan K, et al. Evaluation of the accuracy of cuffless blood pressure measurement devices: challenges and proposals. Hypertension 2021;78:1161-7.
  21. Lee YH, Hur SH, Sohn J, et al. Impact of home-based exercise training with wireless monitoring on patients with acute coronary syndrome undergoing percutaneous coronary intervention. J Korean Med Sci 2013;28:564-8.
  22. Chung H, Ko H, Thap T, et al. Smartphone-based CR program: feasibility study. PLoS One 2016;11:e0161268.
  23. Lee H, Chung H, Ko H, et al. Dedicated CR wearable sensor and its clinical potential. PLoS One 2017;12:e0187108.
  24. Sakakibara Heart Institute. Remote CR System, TeleRehab [Internet]. Tokyo: Sakakibara Heart Institute; 2022 [cited 2023 August 20]. Available from: https://heart-rehab.jp/informations/43/. 
  25. Watson A, Chapman R, Shafai G, Maricich YA. FDA regulations and prescription digital therapeutics: evolving with the technologies they regulate. Front Digit Health 2023;5:1086219.
  26. Tzeis S, Asvestas D, Moraitis N, et al. Safety of smartwatches and their chargers in patients with cardiac implantable electronic devices. Europace 2021;23:99-103.
  27. American Heart Association. New telehealth certification available to health care professionals [Internet]. Chicago (IL): American Heart Association; 2023 [cited 2023 August 20]. Available from: https://newsroom.heart.org/news/new-telehealth-certification-available-to-health-care-professionals. 
  28. Centers for Medicare & Medicaid Services. COVID-19 emergency declaration blanket waivers for health care providers [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; 2021 [cited 2023 August 20]. Available from: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf. 
  29. Jiang X, Xie H, Tang R, et al. Characteristics of online health care services from China's largest online medical platform: cross-sectional survey study. J Med Internet Res 2021;23:e25817.
  30. Jones RB, Tredinnick-Rowe J, Baines R, Maramba ID, Chatterjee A. Use and usability of GP online services: a mixed-methods sequential study, before and during the COVID-19 pandemic, based on qualitative interviews, analysis of routine eConsult usage and feedback data, and assessment of GP websites in Devon and Cornwall, England. BMJ Open 2022;12:e058247.
  31. Sadeghi M, Rahiminam H, Amerizadeh A, et al. Prevalence of return to work in cardiovascular patients after CR: a systematic review and meta-analysis. Curr Probl Cardiol 2022;47:100876.
  32. Nakayama A. CR team-led employment support including remote employment support. SHINZO 2023;55:554-8. 
  33. Ades PA, Huang D, Weaver SO. CR participation predicts lower rehospitalization costs. Am Heart J 1992;123:916-21.
  34. Ades PA, Pashkow FJ, Nestor JR. Cost-effectiveness of CR after myocardial infarction. J Cardiopulm Rehabil 1997;17:222-31.
  35. Frederix I, Hansen D, Coninx K, et al. Effect of comprehensive cardiac telerehabilitation on one-year cardiovascular rehospitalization rate, medical costs and quality of life: a cost-effectiveness analysis. Eur J Prev Cardiol 2016;23:674-82. 
  36. Kidholm K, Rasmussen MK, Andreasen JJ, et al. Cost-utility analysis of a cardiac telerehabilitation program: the teledialog project. Telemed J E Health 2016;22:553-63.
  37. Senanayake S, Halahakone U, Abell B, et al. Hybrid cardiac telerehabilitation for coronary artery disease in Australia: a cost-effectiveness analysis. BMC Health Serv Res 2023;23:512.