Is there a possibility of changing lifestyle and physical activity in patients with chronic heart failure and type II diabetes? A telemedicine home-based experience

Heart failure and type 2 diabetes are prevalent public health issues.

This study aimed to evaluate the effectiveness of a 6-month telemedicine program for managing patients at home. The focus was on promoting lifestyle changes and assessing the applicability and usability of devices and apps.

Patients were randomly assigned to an Intervention Group (IG) or a Control Group (CG). The IG received weekly teleassistance via phone or video from a nurse case manager and used a portable electrocardiograph, step tracker, and a smartphone app for communication (Figure 1). The CG received standard care, including visits from their general practitioner. The primary outcome was the difference in distance walked at 6-minute walk test between baseline and six months later (6MWT). Secondary outcomes included improvements in the physical activity profile (PASE), quality of life questionnaires, clinical parameters, and biomarkers. The IG also assessed patient satisfaction with the program and the usability of the devices and app using the System Usability Scale (SUS).

This study included 163 patients, predominantly male (84%), with 82 in the intervention group (IG) and 81 in the control group (CG). The mean age was 71±9 years in the IG and 74±8 years in the CG. Patients in the IG had an average of 21 ± 7.5 scheduled contacts, totaling 1,751. Most actions focused on medications (28%) and physical treatments (52%), along with educational initiatives (41%). The IG recorded an average of 23 ± 11 ECGs per patient and 34,737 ± 17,511 steps weekly, averaging 7,721 ± 3,889 steps daily.Primary outcome: After six months, the IG showed a mean increase of 12.4 meters (95% CI [1.7, 23.1]; p=0.0168) in the distance walked during the 6MWT, while the CG experienced a decrease of -22.4 meters (95% CI [-36, -8.9]; p=0.0029). The difference in the change in distance walked between the groups was statistically significant (p=0.0001). Regarding physical activity, the PASE scores in the IG revealed a slight increase, though not statistically significant (p=0.2914). Conversely, the CG had a significant decrease in their PASE scores over the 6-month period (p=0.0242), indicating a meaningful difference between the two groups at the 6-month mark (p=0.0164). No significant changes were observed in the quality of life questionnaires. Figure 2 presents the results for clinical parameters and biomarkers.

Patient satisfaction was high, with an overall score of 19.4 ± 4.2. Of 72 IG respondents, 25% rated the system as excellent, 21% as good, 39% as fair, and 15% as poor. Conclusions: The study demonstrates the effectiveness of a telemedicine program in promoting healthy lifestyles in patients with HF and T2DM. It enhanced self-management, empowered patients, and improved awareness of their conditions. Although the technology may be complex for an elderly population, it can be better accepted when perceived as beneficial to the patients and their families.

Technology model of the protocol