Digital Cardiac Rehabilitation Programs: The Future of Patient-Centered Medicine.

Background: The low participation rate in cardiac rehabilitation programs is the major reason for rehospitalization, morbidity, and mortality. Home-based cardiac rehabilitation by technological means is an essential component of a "patient-centered" approach, which is capable of enhancing the participation rate in rehabilitation programs. Introduction: The aim of this research was to examine attitudes, perceptions, and behavioral intentions toward remote digital cardiac rehabilitation (RDCR) with respect to factors such as age, education, smoking, exercise habits, technological illiteracy, and mobile phone behavior. Materials and Methods: This was a cross-sectional study of 200 adult patients discharged from a hospital after an acute coronary syndrome, cardiac surgery, or percutaneous coronary intervention. All patients answered an anonymous Technology Usage Questionnaire, which examined the relationship between their willingness to participate in the RDCR program and various parameters. The surveys were distributed and completed between July 2017 and November 2017 at the Sheba Medical Center in Israel. Results: Overall, 83% of all participants were interested in participating in the RDCR program. Those with heart failure had a greater interest in the program (100%; p < 0.05), whereas patients after coronary bypass surgery had a lesser interest (71.1%; p < 0.05). The level of attitude toward healthy lifestyle was found to be a significant predictor of willingness to participate in RDCR (odds ratio 2.26; p = 0.01). Sociodemographic characteristics, lifestyle, habits, technological knowledge, age, and gender were not found as significant predictors of interest in RDCR. Conclusions: The RDCR program was acceptable to most cardiac patients, including the elderly population, and could be a potential solution for patients who avoid traditional rehabilitation programs in medical centers.

Feasibility, Safety, and Effectiveness of a Mobile Application in Cardiac Rehabilitation.

BACKGROUND: Cardiac rehabilitation (CR) is underutilized globally despite evidence of clinical benefit. Major obstacles for wider adoption include distance from the rehabilitation center, travel time, and interference with daily routine. Tele-cardiac rehabilitation (tele-CR) can potentially address some of these limitations, enabling patients to exercise in their home environment or community. OBJECTIVES: To evaluate the clinical and physiological outcomes as well as adherence to tele-CR in patients with low cardiovascular risk and to assess exercise capacity, determined by an exercise stress test, using a treadmill before and following the 6-month intervention. METHODS: A total of 22 patients with established coronary artery disease participated in a 6-month tele-CR program. Datos Health (Ramat Gan, Israel), a digital health application and care-team dashboard, was used for remote monitoring, communication, and management of the patients. RESULTS: Following the 6-month tele-CR intervention, there was significant improvement in exercise capacity, assessed by estimated metabolic equivalents with an increase from 10.6 ± 0.5 to 12.3 ± 0.5 (P = 0.002). High-density lipoproteins levels significantly improved, whereas low-density lipoproteins, triglyceride, glycosylated hemoglobin, and systolic and diastolic blood pressure levels were not significantly changed. Exercise adherence was consistent among patients, with more than 63% of patients participating in a moderate intensity exercise program for 150 minutes per week. CONCLUSIONS: Patients who participated in tele-CR adhered to the exercise program and attained clinically significant functional improvement. Tele-CR is a viable option for populations that cannot, or elect not to, participate in center-based CR programs.

[FROM 'REMOTE CARDIAC REHABILITATION' TO CHRONIC DISEASE MANAGEMENT PROGRAMS BY DIGITAL MEANS - REVIEW OF THE NATIONAL PROGRAM AS A MODEL FOR MULTI-DISCIPLINARY DISEASE MANAGEMENT].

INTRODUCTION: Cardiovascular diseases, often accompanied by many background diseases, are the main cause of morbidity and mortality globally. Cardiac rehabilitation programs are a key component of secondary prevention and lack of participation or adherence lead to significantly higher adverse event rates including hospitalization and mortality. Technological means have great potential for improving health care outcomes. Home-cardiac rehabilitation (H-CR) using technology implements the 'patient-centered' approach within the health services. Last year, the Israeli Ministry of Health approved the H-CR program for a low-risk patient and included it into medical coverage of the state. In accordance with the Ministry of Health circular, the H-CR program is implemented at the Sheba Medical Center since November 2018. The program incorporates innovative technology alongside multi-professional care. Implementation of the program enables studies about the methods to put into effect the therapeutic model in other chronic disease management, including home rehabilitation or hospitalization programs, while maintaining patient safety and securing medical information. The purpose of this article is to review the first H-CR program in Israel, its components, benefits, and challenges, as well as, to present the therapeutic model, its competence in multidisciplinary disease management and increased responsiveness to the treatment.