Feasibility of hybrid telerehabilitation as a component of Managed Care after Acute Myocardial Infarction (MC-AMI) in a 12-month follow-up: experience from a single center

Abstract

Introduction: Managed Care after Myocardial Infarction (MC-AMI), a comprehensive care program after myocardial infarction, was implemented in Poland. Hybrid cardiac telerehabilitation (HTR) is a unique component of MC-AMI.

Objectives: We evaluated the feasibility of HTR as a component of MC-AMI and assessed its safety and acceptance by patients. One-year all-cause mortality among patients covered and not covered by MC-AMI was analyzed.

Patients and methods: The MC-AMI group included 114 patients who underwent the 5-week HTR program based on telemonitored Nordic walking training sessions and the entire 12-month MC-AMI. The influence of HTR on physical capacity was assessed by comparing the stress test results before and after HTR. After HTR, subjects completed a satisfaction survey to assess their acceptance of HTR. Non-MC-AMI group was formed using propensity score matching to compare one-year all-cause mortality between the groups.

Results: HTR significantly improved the functional capacity assessed on the stress test. The patients accepted HTR very well. In study group, non-fatal non-ST-elevation myocardial infarction, elective coronary percutaneous intervention and cardiovascular hospitalization occured in 0.9%, 2.6% and 6.1%, respectively. There were no deaths among MC-AMI participants and one-year all-cause mortality was 3.5% in non-MC-AMI group. The log-rank test comparing the survival probabilities of matched groups, estimated by the Kaplan-Meier method, showed heterogeneity of the curves (p=0.04).

Conclusions: HTR as a component of MC-AMI was a feasible, safe, and well-accepted form of cardiac rehabilitation. Participation in MC-AMI including HTR was associated with a statistically significant lower risk of 1-year all-cause mortality when compared with non-MC-AMI group.