Kardiyovasküler Hastalıklarda Telerehabilitasyon

Kardiyovasküler hastalıklar dünya çapında ana ölüm nedenidir. Yüksek ölüm oranına bağlı olarak sağlık sisteminde ekonomik yük artmaktadır. Dünya Sağlık Örgütü (DSÖ) tarafından 2016 yılında kardiyovasküler hastalıklar nedeniyle yaklaşık 17,9 milyon ölüm olduğu (%31) rapor edilmiştir. Gelişmiş ülkelerde toplumların yaşlanması ve yaşam ömrünün uzaması kardiyovasküler hastalıkların sayısını artırmaktadır. Ülkemizin nüfus yapısı halen genç nüfus olmakla birlikte gelişmekte olan ülkelere benzerdir. Kardiyovasküler hastalıklarda kardiyak rehabilitasyon mortalite ve yeniden hastaneye yatışı azaltmada maliyeti uygun çok bileşenli etkili bir müdahaledir. Kardiyak rehabilitasyonun kanıtlanmış faydalarına rağmen hastaların kardiyak rehabilitasyon programlarına katılımı düşüktür. Güncel kılavuzlar kardiyovasküler hastalıkların önlenmesinde kapsamlı kardiyak rehabilitasyona ve hastaların kardiyak rehabilitasyon programlarına katılımına odaklanmaktadır. Son yıllarda kardiyak rehabilitasyon programlarına katılımı artırmak amacıyla kardiyovasküler hastalıklarda ‘‘kardiyak telerehabilitasyon’’ modeli yeni bir strateji olarak uygulanmaktadır. Bu derlemede kardiyovasküler hastalıklarda kanıta dayalı telerehabilitasyon uygulamaları incelenmiştir. Sonuç olarak düşük ve orta riskli koroner arter hastalarında telerehabilitasyonun güvenli ve etkin olduğu, bununla birlikte yüksek riskli kardiyak hastalarda çalışmaların az ve sınırlı olduğu görülmektedir. Kardiyovasküler hastalıklarda telerehabilitasyona yönelik teknolojik yaklaşımların uzun vadeli etkinliği ve güvenliği için daha fazla çalışmaya ihtiyaç vardır.

Anahtar Kelimeler:

Kardiyak rehabilitasyon, Rehabilitasyon, Telerehabilitasyon, Teletıp

Telerehabilitation in Cardiovascular Diseases

Cardiovascular diseases are the main cause of death in worldwide. Due to the high mortality rate, the economic burden is increasing in the health system. It was reported by the World Health Organization (WHO) that there were approximately 17.9 million deaths (31%) due to cardiovascular diseases in 2016. In developed countries, the aging of societies and the prolongation of life expectancy increase the number of cardiovascular diseases. Although the population structure of our country is still young, it is similar to developing countries. Cardiac rehabilitation in cardiovascular diseases is a cost-effective multi-component intervention to reduce mortality and rehospitalization. Despite the proven benefits of cardiac rehabilitation, patient participation in cardiac rehabilitation programs is low. Current guidelines focus on comprehensive cardiac rehabilitation and patient participation in cardiac rehabilitation programs for the prevention of cardiovascular disease. In recent years ‘‘cardiac telerehabilitation’’ model in cardiovascular diseases has been implemented as new strategy to increase participation in cardiac rehabilitation programs. In this review evidence-based telerehabilitation practices in cardiovascular diseases were examined. In conclusion telerehabilitation seems to be safe and effective procedure in coronary artery patients who have low and moderate risk, however studies are few and limited in high risk cardiac patients. More studies are needed to determine the long-term efficacy and safety of the technological approaches for telerehabilitation in cardiovascular diseases.

Keywords:

Cardiac rehabilitation, Rehabilitation, Telerehabilitation, Telemedicine,

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Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I et al. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2021;28(5):460-495.
World Health Organization. Noncommunicable diseases country profiles 2018. World Health Organization. https://apps.who.int/iris/handle/10665/274512, 223 p.
Şencan I, Keskinkılıç B, Ekinci B, Öztemel A, Sarıoğlu G, Çobanoğlu N et al. Türkiye Kalp ve Damar Hastalıkları Önleme ve Kontrol Programı Eylem Planı (2015-2020). TC Türkiye Halk Sağlığı Kurumu, TC Sağlık Bakanlığı Yayın. 2015;(988), 1-63.
Winnige P, Vysoky R, Dosbaba F, Batalik L. Cardiac rehabilitation and its essential role in the secondary prevention of cardiovascular diseases. World J Clin Cases. 2021;9(8):1761.
Scherrenberg M, Wilhelm M, Hansen D, Völler H, Cornelissen V, Frederix I et al. The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2021;28(5):524-540.
Brouwers RWM, van Exel HJ, van Hal JMC, Jorstad HT, de Kluiver EP, Kraaijenhagen RA et al. Committee for Cardiovascular Prevention and Cardiac Rehabilitation of the Netherlands Society of Cardiology. Cardiac telerehabilitation as an alternative to centre-based cardiac rehabilitation. Neth Heart J. 2020;28(9):443-451.
Vonk T, Bakker EA, Zegers ES, Hopman MT, Eijsvogels TM. Effect of a personalised mHealth home-based training application on physical activity levels during and after centre-based cardiac rehabilitation: rationale and design of the Cardiac RehApp randomised control trial. BMJ Open Sport Exerc Med. 2021;7(3):e001159.
Piepoli M F, Abreu A, Albus C, Ambrosetti M, Brotons C, Catapano AL et al. Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology. Eur J Prev Cardiol. 2020; 27(2):181-205.
Frederix I, Vandijck D, Hens N, De Sutter J, Dendale P. Economic and social impact of increased cardiac rehabilitation uptake and cardiac telerehabilitation in Belgium–a cost–benefit analysis. Acta Cardiol. 2018; 73(3):222-229.
Coorey GM, Neubeck L, Mulley J, Redfern J. Effectiveness, acceptability and usefulness of mobile applications for cardiovascular disease self-management: Systematic review with meta-synthesis of quantitative and qualitative data. Eur J Prev Cardiol. 2018; 25(5):505-521.
Batalik L, Filakova K, Batalikova K, Dosbaba F. Remotely monitored telerehabilitation for cardiac patients: A review of the current situation. World J Clin Cases. 2020; 8:1818-1831.
Huang K, Liu W, He D, Huang B, Xiao D, Peng Y et al. Telehealth interventions vs center-based cardiac rehabilitation of coronary artery disease: A systematic review and meta-analysis. Eur J Prev Cardiol. 2015; 22:959-971
Trecarten N, Kirkland S, Rainham D, Giacomantonio N, McGowan E, Murnaghan D et al. Location-Based Sedentary Time and Physical Activity in People Living With Coronary Artery Disease. J Cardiopulm Rehabil Prev. 2021; 41(4):337-342.
Milewski K, Małecki A, Orszulik-Baron D, Kachel M, Hirnle P, Orczyk M et al. The use of modern telemedicine technologies in an innovative optimal cardiac rehabilitation program for patients after myocardial revascularization: Concept and design of RESTORE, a randomized clinical trial. Cardiol J. 2019; 26(5): 594-603.
Nabutovsky I, Ashri S, Nachshon A, Tesler R, Shapiro Y, Wright E et al. Feasibility, Safety, and Effectiveness of a Mobile Application in Cardiac Rehabilitation. Isr Med Assoc J. 2020; 22(6):357-363.
Claes J, Buys R, Budts W, Smart N, Cornelissen VA. Longer-term effects of home-based exercise interventions on exercise capacity and physical activity in coronary artery disease patients: A systematic review and meta-analysis. Eur J Prev Cardiol. 2017; 24(3):244-256.
Avila A, Claes J, Buys R, Azzawi M, Vanhees L, Cornelissen V. Home-based exercise with telemonitoring guidance in patients with coronary artery disease: Does it improve long-term physical fitness? Eur J Prev Cardiol. 2020; 27(4):367-377.
Hwang R, Bruning J, Morris N, Mandrusiak A, Russell T. A systematic review of the effects of telerehabilitation in patients with cardiopulmonary diseases. J Cardiopulm Rehabil Prev. 2015; 35(6):380-389.
Kraal J J, Van den Akker-Van Marle M E, Abu-Hanna A, Stut W, Peek N, Kemps H M. Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the FIT@ Home study. ? Eur J Prev Cardiol. 2017; 24(12):1260-1273.
Oerkild B, Frederiksen M, Hansen JF, Prescott E. Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial. BMJ open. 2012; 2(6):e001820.
Van Veen E, Bovendeert JF, Backx FJ, Huisstede BM. E-coaching: New future for cardiac rehabilitation? A systematic review. Patient Educ Couns. 2017; 100(12):2218-2230.
Xia TL, Huang FY, Peng Y, Huang BT, Pu XB, Yang Y et al. Efficacy of different types of exercise-based cardiac rehabilitation on coronary heart disease: a network meta-analysis. J Gen Intern Med. 2018; 33(12):2201-2209.
Wongvibulsin S, Habeos EE, Huynh PP, Xun H, Shan R, Rodriguez KAP et al. Digital health interventions for cardiac rehabilitation: systematic literature review. J Med Internet Res. 2021; 23(2):e18773.
Bravo-Escobar R, González-Represas A, Gómez-González AM, Montiel-Trujillo A, Aguilar-Jimenez R, Carrasco-Ruíz R et al. Effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic heart disease at moderate cardiovascular risk: A randomised, controlled clinical trial. BMC Cardiovasc Disord. 2017; 17(1):1-11.
Kraal JJ, Peek N, Van den Akker-Van Marle ME, Kemps HM. Effects of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: short-term results of the FIT@ Home study. Eur J Prev Cardiol. 2014; 21(2 Suppl):26-31.
Chockalingam A, Chan A, Kanaley JA, Aggarwal K. Home-Based Arm Cardiac Rehabilitation in Disabled Veterans: A Pilot Study. Mo Med. 2021; 118(4):387.
Skobel E, Knackstedt C, Martinez-Romero A, Salvi D, Vera-Munoz C, Napp A et al. Internet-based training of coronary artery patients: the Heart Cycle Trial. Heart Vessels. 2017; 32(4):408-418.
Brouwers RW, Kraal JJ, Traa SC, Spee RF, Oostveen LM, Kemps H. Effects of cardiac telerehabilitation in patients with coronary artery disease using a personalised patient-centred web application: protocol for the SmartCare-CAD randomised controlled trial. BMC Cardiovasc Disord. 2017; 17(1):1-11.
Claes J, Cornelissen V, McDermott C, Moyna N, Pattyn N, Cornelis N et al. Feasibility, Acceptability, and Clinical Effectiveness of a Technology-Enabled Cardiac Rehabilitation Platform (Physical Activity Toward Health-I): Randomized Controlled Trial. J Med Internet Res. 2020; 22:e14221
Szalewska D, Niedoszytko P, Gierat-Haponiuk K. The impact of professional status on the effects of and adherence to the outpatient followed by home-based telemonitored cardiac rehabilitation in patients referred by a social insurance institution. Int J Occup Med Environ Health. 2015; 28(4):761.
Batalik L, Konecny V, Dosbaba F, Vlazna D, Brat K. Cardiac rehabilitation based on the walking test and telerehabilitation improved cardiorespiratory fitness in people diagnosed with coronary heart disease during the COVID-19 pandemic. Int J Environ Res Public Health. 2021; 18(5):2241.
Meinhart F, Stütz T, Sareban M, Kulnik ST, Niebauer J. Mobile technologies to promote physical activity during cardiac rehabilitation: a scoping review. Sensors (Basel). 2020; 21(1):65.
Uddin J, Joshi VL, Moniruzzaman M, Karim R, Uddin J, Siraj M et al. Effect of home-based cardiac rehabilitation in a lower-middle income country: results from a controlled trial. J Cardiopulm Rehabil Prev. 2020; 40(1):29-34.
Hwang R, Bruning J, Morris NR, Mandrusiak A, Russell T. Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: a randomised trial. J Physiother. 2017; 63(2):101-107.
Peng X, Su Y, Hu Z, Sun X, Li X, Dolansky MA et al. Home-based telehealth exercise training program in Chinese patients with heart failure: a randomized controlled trial. Medicine (Baltimore). 2018; 97(35).
Piotrowicz E, Zieliński T, Bodalski R, Rywik T, Dobraszkiewicz-Wasilewska B, Sobieszczańska-Małek M et al. Home-based telemonitored Nordic walking training is well accepted, safe, effective and has high adherence among heart failure patients, including those with cardiovascular implantable electronic devices: a randomised controlled study. Eur J Prev Cardiol. 2015; 22(11):1368-1377.
Schröder J, Van Criekinge T, Embrechts E, Celis X, Van Schuppen J, Truijen S et al. Combining the benefits of tele-rehabilitation and virtual reality-based balance training: a systematic review on feasibility and effectiveness. Disabil Rehabil Assist Technol. 2019; 14(1):2-11.
Boulanger P, Mott W, Schaeffer S, Wood PW, Padwal R, Raggi P. MedBike: Virtual Reality for Remote Cardiac Rehabilitation. Assistive and Rehabilitation Engineering. 4th ed, Sweden: IntechOpen; 2019.