Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial.

OBJECTIVE Compare the effects and costs of remotely monitored exercise based cardiac telerehabilitation REMOTE CR with centre based programmes CBexCR in adults with coronary heart disease CHD METHODS Participants were randomised to receive 12 weeks of telerehabilitation or centre based rehabilitation REMOTE CR provided individualised exercise prescription real time exercise monitoring coaching and theory based behavioural strategies via a bespoke telerehabilitation platform CBexCR provided individualised exercise prescription and coaching via established rehabilitation clinics Outcomes assessed at baseline 12 and or 24 weeks included maximal oxygen uptake V O2max primary modifiable cardiovascular risk factors exercise adherence motivation health related quality of life and programme delivery hospital service utilisation and medication costs The primary hypothesis was a non inferior between group difference in V O2max at 12 weeks inferiority margin 1 25 mL kg min inferiority margins were not set for secondary outcomes RESULTS 162 participants mean 61 12 7 years 86 men were randomised V O2 max was comparable in both groups at 12 weeks and REMOTE CR was non inferior to CBexCR REMOTE CR CBexCR adjusted mean difference AMD 0 51 95 CI 0 97 to 1 98 mL kg min p 0 48 REMOTE CR participants were less sedentary at 24 weeks AMD 61 5 95 CI 117 8 to 5 3 min day p 0 03 while CBexCR participants had smaller waist AMD 1 71 95 CI 0 09 to 3 34 cm p 0 04 and hip circumferences AMD 1 16 95 CI 0 06 to 2 27 cm p 0 04 at 12 weeks No other between group differences were detected Per capita programme delivery NZD1130 GBP573 vs NZD3466 GBP1758 and medication costs NZD331 GBP168 vs NZD605 GBP307 p 0 02 were lower for REMOTE CR Hospital service utilisation costs were not statistically significantly different NZD3459 GBP1754 vs NZD5464 GBP2771 p 0 20 CONCLUSION REMOTE CR is an effective cost efficient alternative delivery model that could as a complement to existing services improve overall utilisation rates by increasing reach and satisfying unique participant preferences