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Remote model in the system of outpatient cardioreabilitation in subjects with chronic heart failure

Session Poster Session 1

Speaker Nadezda Lyamina

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Rehabilitation
  • Session type : Poster Session

Authors : N Lyamina (Saratov,RU), E Kotelnikova (Saratov,RU), V Senchikhin (Saratov,RU), T Lipchanskaya (Saratov,RU)

Authors:
N Lyamina1 , E Kotelnikova1 , V Senchikhin1 , T Lipchanskaya1 , 1Research Institute of Cardiology Saratov State Medical University named after V.I. Razumovskiy - Saratov - Russian Federation ,

Citation:

Background : The remote management of treatment and rehabilitation process including self-management, telemedical healthcare and remote monitoring (RM) can be executed for outpatient cardiac rehabilitation (CR) in subjects with chronic heart failure (CHF). Purpose. Remote observational model evaluation in outpatient CR in subjects with I-III NYHA CHF after myocardial infarction (MI).

Methods : The study included 24 subjects: 22/91.7% of men, 55.3±8.3 y.o.; NYHA 2.04±0.25; 75% after PCI due to MI; mean GRACE scale score  92±12. Home CR programs included controlled walking 5 times/week. Remote rehabilitation monitoring (3 months) included ECG autotransmitting, physical activity and physiological indicators control, asynchronous telemedicine and office counseling. ECG telemonitoring was performed by the principle of autotransmitting with mobile devices and the ECG Dongle Internet application. Physical activity (PA) was measured by Beurer AS80 digital pedometer with transmitting data to the smartphone and the mobile application Easyfit (GmbH, Germany). PA tolerance was estimated in Borg scale points. Type of attitude towards the disease was assessed by the LOBI questionnaire. Remote correction of rehabilitation assignment was carried out in the mode of asynchronous telemedicine counseling; correction of drug therapy was performed during office counseling. CR effectiveness was assessed by the results of 6-min walk distance test (WDT) and the dynamics of NYHA functional class, as well as the patients’ activity indices in the RM system and dynamics of the personal response to the disease.

Results : Patients with I-III NYHA CHF were included in the RM program on 31±5 days of MI. Initially disadaptive behavioral reactions prevailed (87.0%). No signs of personal disadaptation had 12.5% subjects. According to the RM parameters data transmission was stopped by 3 patients (12.5% of participants) after 4±1.2 weeks of follow up. After 3 months of CR with a walking time of 37±5 min/day, average number of 3223.6±27.7 steps/day, total distance traveled 9.9±2.7 km/week and a stable subjective reaction (0.6±0.3 and 0.7±0.2 Borg scale points) the dynamics of WDT (443±32 m vs. 352±27, p <0.05) and NYHA CHF (1.71 vs. 2.04, p <0.05) were observed. Asymptomatic episodes of myocardial ischemia were recorded in 2 subjects (9.5%); rhythm disturbances - in 8 (38.1%). The number of patients with minimal manifestations of maladjustment increased (12.5% vs 33.3%, p <0.001). The proportion of  subjects with intrapsychic orientation disorders was slightly decreased (from 66.7% to 61.9%).

Conclusions : The RM system based on mobile communication is successful as a model of rehabilitation care for outpatient management in CHF patients. The complex predisposing factor of RM application is to increase the motivation of patients by involving them in the self-management process improving the quality of communication between the doctor and the patient and increasing patients’ physical activity.

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