Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study
BackgroundRisk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities,...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2023-12-01
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| Series: | JMIR Cardio |
| Online Access: | https://cardio.jmir.org/2023/1/e49345 |
| _version_ | 1797391284684455936 |
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| author | Satish Misra Karen Niazi Kamala Swayampakala Amanda Blackmon Melissa Lang Elizabeth Davenport Sherry Saxonhouse John Fedor Brian Powell Joseph Thompson John Holshouser Rohit Mehta |
| author_facet | Satish Misra Karen Niazi Kamala Swayampakala Amanda Blackmon Melissa Lang Elizabeth Davenport Sherry Saxonhouse John Fedor Brian Powell Joseph Thompson John Holshouser Rohit Mehta |
| author_sort | Satish Misra |
| collection | DOAJ |
| description |
BackgroundRisk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities, insurance coverage, work or home responsibilities, and transportation. Digital health technology offers an opportunity to address this gap and offer scalable interventions for risk factor modification.
ObjectiveThis study aims to assess the feasibility and effectiveness of a 12-week asynchronous remotely supervised exercise and patient education program, modeled on cardiac rehabilitation programs, in patients with AF.
MethodsA total of 12 patients undergoing catheter ablation of AF were enrolled in this pilot study. Participants met with an exercise physiologist for a supervised exercise session to generate a personalized exercise plan to be implemented over the subsequent 12-week program. Disease-specific education was also provided as well as instruction in areas such as blood pressure and weight measurement. A digital health toolkit for self-tracking was provided to facilitate monitoring of exercise time, blood pressure, weight, and cardiac rhythm. The exercise physiologist remotely monitored participants and completed weekly check-ins to titrate exercise targets and provide further education. The primary end point was program completion. Secondary end points included change in self-tracking adherence, weight, 6-minute walk test (6MWT), waist circumference, AF symptom score, and program satisfaction.
ResultsThe median participant age was 67.5 years, with a mean BMI of 33.8 kg/m2 and CHADs2VASC (Congestive Heart Failure, Hypertension, Age [≥75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]) of 1.5. A total of 11/12 (92%) participants completed the program, with 94% of expected check-ins completed and 2.9 exercise sessions per week. Adherence to electrocardiogram and blood pressure tracking was fair at 81% and 47%, respectively. Significant reductions in weight, waist circumference, and BMI were observed with improvements in 6MWT and AF symptom scores (P<.05) at the completion of the program. For program management, a mean of 2 hours per week or 0.5 hours per patient per week was required, inclusive of time for follow-up and intake visits. Participants rated the program highly (>8 on a 10-point Likert scale) in terms of the impact on health and wellness, educational value, and sustainability of the personal exercise program.
ConclusionsAn asynchronous remotely supervised exercise program augmented with AF-specific educational components for patients with AF was feasible and well received in this pilot study. While improvements in patient metrics like BMI and 6MWT are encouraging, they should be viewed as hypothesis generating. Based on insights gained, future program iterations will include particular attention to improved technology for data aggregation, adjustment of self-monitoring targets based on observed adherence, and protocol-driven exercise titration. The study design will need to incorporate strategies to facilitate the recruitment of a diverse and representative participant cohort. |
| first_indexed | 2024-03-08T23:29:43Z |
| format | Article |
| id | doaj.art-5722cc0a2dab43f4821d66c25670e050 |
| institution | Directory Open Access Journal |
| issn | 2561-1011 |
| language | English |
| last_indexed | 2024-03-08T23:29:43Z |
| publishDate | 2023-12-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Cardio |
| spelling | doaj.art-5722cc0a2dab43f4821d66c25670e0502023-12-14T14:45:44ZengJMIR PublicationsJMIR Cardio2561-10112023-12-017e4934510.2196/49345Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot StudySatish Misrahttps://orcid.org/0000-0003-1214-5568Karen Niazihttps://orcid.org/0009-0002-0100-5682Kamala Swayampakalahttps://orcid.org/0000-0002-5436-0154Amanda Blackmonhttps://orcid.org/0009-0001-4945-4009Melissa Langhttps://orcid.org/0000-0001-8819-5479Elizabeth Davenporthttps://orcid.org/0000-0003-1085-2066Sherry Saxonhousehttps://orcid.org/0009-0008-9142-1383John Fedorhttps://orcid.org/0009-0001-6741-166XBrian Powellhttps://orcid.org/0009-0001-8253-3489Joseph Thompsonhttps://orcid.org/0009-0002-3758-1219John Holshouserhttps://orcid.org/0009-0002-4165-7079Rohit Mehtahttps://orcid.org/0000-0001-5321-5679 BackgroundRisk factor modification, in particular exercise and weight loss, has been shown to improve outcomes for patients with atrial fibrillation (AF). However, access to structured supporting programs is limited. Barriers include the distance from appropriate facilities, insurance coverage, work or home responsibilities, and transportation. Digital health technology offers an opportunity to address this gap and offer scalable interventions for risk factor modification. ObjectiveThis study aims to assess the feasibility and effectiveness of a 12-week asynchronous remotely supervised exercise and patient education program, modeled on cardiac rehabilitation programs, in patients with AF. MethodsA total of 12 patients undergoing catheter ablation of AF were enrolled in this pilot study. Participants met with an exercise physiologist for a supervised exercise session to generate a personalized exercise plan to be implemented over the subsequent 12-week program. Disease-specific education was also provided as well as instruction in areas such as blood pressure and weight measurement. A digital health toolkit for self-tracking was provided to facilitate monitoring of exercise time, blood pressure, weight, and cardiac rhythm. The exercise physiologist remotely monitored participants and completed weekly check-ins to titrate exercise targets and provide further education. The primary end point was program completion. Secondary end points included change in self-tracking adherence, weight, 6-minute walk test (6MWT), waist circumference, AF symptom score, and program satisfaction. ResultsThe median participant age was 67.5 years, with a mean BMI of 33.8 kg/m2 and CHADs2VASC (Congestive Heart Failure, Hypertension, Age [≥75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female]) of 1.5. A total of 11/12 (92%) participants completed the program, with 94% of expected check-ins completed and 2.9 exercise sessions per week. Adherence to electrocardiogram and blood pressure tracking was fair at 81% and 47%, respectively. Significant reductions in weight, waist circumference, and BMI were observed with improvements in 6MWT and AF symptom scores (P<.05) at the completion of the program. For program management, a mean of 2 hours per week or 0.5 hours per patient per week was required, inclusive of time for follow-up and intake visits. Participants rated the program highly (>8 on a 10-point Likert scale) in terms of the impact on health and wellness, educational value, and sustainability of the personal exercise program. ConclusionsAn asynchronous remotely supervised exercise program augmented with AF-specific educational components for patients with AF was feasible and well received in this pilot study. While improvements in patient metrics like BMI and 6MWT are encouraging, they should be viewed as hypothesis generating. Based on insights gained, future program iterations will include particular attention to improved technology for data aggregation, adjustment of self-monitoring targets based on observed adherence, and protocol-driven exercise titration. The study design will need to incorporate strategies to facilitate the recruitment of a diverse and representative participant cohort.https://cardio.jmir.org/2023/1/e49345 |
| spellingShingle | Satish Misra Karen Niazi Kamala Swayampakala Amanda Blackmon Melissa Lang Elizabeth Davenport Sherry Saxonhouse John Fedor Brian Powell Joseph Thompson John Holshouser Rohit Mehta Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study JMIR Cardio |
| title | Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study |
| title_full | Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study |
| title_fullStr | Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study |
| title_full_unstemmed | Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study |
| title_short | Outcomes of a Remote Cardiac Rehabilitation Program for Patients Undergoing Atrial Fibrillation Ablation: Pilot Study |
| title_sort | outcomes of a remote cardiac rehabilitation program for patients undergoing atrial fibrillation ablation pilot study |
| url | https://cardio.jmir.org/2023/1/e49345 |
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