patients

A 12-lead electrocardiogram was monitored throughout CPET; the rated perceived exertion on the initial Borg scale was recorded at the end of every stage; oxygen uptake and carbon dioxide output were measured every 10 s.
Peak VO2 was defined as the average oxygen consumption during the last 15 s of cycle ergometry.
VE/VCO2 slope was measured by plotting minute ventilation volume against VCO2 obtained every 10 s of exercise.
To potentially reduce this gap, home-based CR can be a beneficial alternative for selected patients.

• Furthermore, the HBCR participants, who lived farther from their nearest available center, were more prone to complete their program.
• Facilities and operational costs for HBCR are generally lower in comparison to center-based cardiac rehab, making HBCR not merely convenient for providers and patients but economically attractive and easy to scale as well.
• HBCR with mobile communication has been used during the past decade, and studies, mostly conducted with text messaging, show promising results on improving CR enrollment, physical exercise, and physical activity capacity (14–17).
• The Smartphone Interaction System, an integral WeChat plug-in app was developed by Halents Life-Info Technologies.
• To add to what’s known about in-home cardiac rehabilitation, researchers from Kaiser Permanente analyzed patients from Kaiser Permanente Southern California , a built-in healthcare system that serves 4.7 million members in racially and ethnically diverse Southern California.

Much like Dorje’s study, we used WeChat, a social app widely used because the main tool to provide HBCR with tele-education, telecommunication, telemonitoring, and data transferring functions .
Cardiac rehabilitation , as a continuum of look after patients with CHD after initial treatment, has been approved to significantly promote wellness, improve exercise capacity, and preserve cardiac function .
In 2018, multiple medical expert agencies established referral to CR as a performance measure .

Clinical Topics

The Smartphone Interaction System, an integral WeChat plug-in app was developed by Halents Life-Info Technologies.
It includes several modules, including the electronic medical management software, an education module displaying educational materials; a fitness data collection module, which collects data from wearable devices; and a reminder module, to remind patients of upcoming clinic visits.
The EMM software contains a database storing patient demographics, clinical measurement, and cardiopulmonary exercise testing results.
An exercise prescription is also in the program, which sends prescriptions automatically to the intervention group monthly.

Ramifications of the Home-Based Cardiac rehabilitation program on psychological state, cardiac symptoms and biochemical metric changes for the matched cohort.
The HBCR program developed by Duke is currently being made designed for use by health systems and providers outside the Duke University Medical Center network via Pattern Health’s secure, HiTRUST certified, HIPAA compliant, and interoperable platform.
Fixed wireless internet from HDER LINK can be acquired to an estimated 144,000 people.

According to a survey, In China, there are only ~500 CR centers nationwide and mostly situated in major cities; the majority of eligible patients are from rural areas plus they do not have an access to CR.
To increase participation and promote health and fitness, a more accessible and flexible style of CR is necessary in China.
Second, our analysis carries a large population of patients that are medically complex.
We used the Charlson Comorbidity Index to judge medical complexity.
The index is trusted as a 12-month mortality risk indicator40 and has been previously validated among patients with CVD.41,42 Nearly 1 / 2 of patients in this study had a Charlson Comorbidity Index score of 4 or higher, that is suggestive of moderate to high risk of 12-month mortality.
Although prior HBCR vs CBCR studies have reported outcomes among patients with higher risk, there’s been considerable heterogeneity regarding the risk measurement use and small sample sizes of patients with the best risk.

This has led to the viewpoint that HBCR studies often are limited to a minority of potential patients—those at lower risk and with fewer comorbidities.43 For example, a report by Bravo-Escobar et al38 sought to examine effectiveness and safety of HBCR in patients with coronary artery disease in Malaga, Spain.
They conducted an RCT of 28 patients with high risk who had undergone CABG or revascularization with PCI.
Taken together, our study increases the HBCR outcomes literature by reporting essential data on previously underrepresented populations, including women, racial and ethnic minority groups, and patients with multiple comorbidities.
Smartphone-based HBCR allows for real-time communication and data exchange between medical staff and patients and promotes personalized exercise prescription and exercise safety.

Main Outcomes And Measures

controlling baseline demographic and clinical variables.
To be able to adjust for different follow-up time, we also included time between the follow-up date and baseline date as a covariate in the model.
Secondary outcomes included changes of CPET, symptoms, risk factors, exercise capacity, standard of living, and psychological outcomes.
Changes in secondary outcomes were calculated by subcontracting baseline measures from follow-up measures.
Paired t-test was used to compare changes between matched HBCR and control.

In this cohort of 2556 patients who participated in CR (mean age, 66.7 [11.2] years, 754 [29.5%] women; 1196 participants [46.8%] with Charlson Comorbidity Index ≥4), there were 289 Asian or Pacific Islander patients (11.3%), 193 Black patients (7.6%), 611 Hispanic patients (23.9%), and 1419 White patients (55.5%).
A complete of 1241 participants (48.5%) received HBCR and 1315 participants (51.5%) received CBCR .

Theoretically, HBCR might help improve delivery of CR to eligible patients by overcoming common barriers that impede a patient’s participation in CBCR, including transportation challenges, competing time demands, and having less CBCR near a patient’s home.
Participants were split between home-based cardiac rehabilitation vs center-based cardiac rehabilitation , with 1241 participants (48.5%) receiving HBCR and 1315 participants (51.5%) receiving CBCR.
We recognize your time and effort and great work from all associates and appreciate project coordinators, investigators, and data operators including Lian Tang, Long-Fang Xing, Hai-Yan Li, Yan-Yan Wei, Xiao-Yan Li, Xiao-Lin Yang, Yan-Yan Yao, Xin Wang, and the patients who participated in the analysis.
Secondly, the sample size was relatively small and all patients were recruited from the single center.
Therefore, a large-scale multi-center is needed to further verify the results.
A multi-center smartphone-based HBCR randomized trial, led by our clinic center, has been initiated and is now in the patient recruitment stage.

HBCR facilitated by telecommunication and monitoring offers a new opportunity.
In this cohort study of 2556 demographically diverse patients with high risk in a big integrated health system, there were fewer hospitalizations at 12 months among participants in home-based CR compared with participants in center-based CR programs.