Impact of cardiac telerehabilitation on risk factor modification in coronary heart disease

Abstract

Overview of the topic: Coronary heart disease (CHD) and cerebrovascular accidents, are the world’s leading killers (WHO, 2018). Cardiac rehabilitation has become the chief method of secondary prevention delivery after a cardiac event (Anderson et al., 2016). However, its utilisation over the years has not been satisfactory (Kotseva et al., 2018), and therefore an ‘evidence-practice gap’ still exists (Jin et al., 2019). Telemedicine, as a novel intervention, may improve the cardiac rehabilitation services in narrowing this gap. The research question: Amongst patients with coronary heart disease, is cardiac telerehabilitation more effective than traditional rehabilitation in modifying risk factors? The PICO elements: The population studied (P) was patients with CHD. The intervention (I) was cardiac telerehabilitation. The comparator (C) was traditional rehabilitation. The desired outcomes (O) were lipid profile, blood pressure, physical activity level, body composition, blood glucose level and smoking status. Method: A literature search using keywords derived from the PICO framework and their synonyms and alternative terms was carried out. Terms were combined using Boolean operators and were searched in Scopus, EBSCO, PubMed, PubMed Central and Proquest for studies published between 2010 and 2019. An inclusion and exclusion criteria (table 2.5) was applied to narrow results and ensure relevance. The PRISMA (2009) checklist and CASP tool (CASP UK, 2019) were used to appraise the selected literature. Results: Eight studies were identified: three meta-analyses; one systematic review; and three randomised control trials. Although inconsistent, cardiac telerehabilitation seems to be noninferior/ superior to traditional rehabilitation for modifying risk factors, and can be offered as an adjunct to current services. Conclusion: Cardiac telerehabilitaion seems to be at least as effective as traditional rehabilitation. However, its specific intervention components are still to be known. Implications and recommendations: Cardiac telerehabilitation can be offered as an adjunct to existing services to overcome some barriers for utilisation. The post for the cardiac telerehabilitation practice nurse and need for further research are outlined.