• „ EDITORIAL

Cost-effectiveness of different models of cardiac telerehabilitation

Martijn Scherrenberg1, 2, Maarten Falter1–3, Paul Dendale1, 2

1Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium

2Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium

3KU Leuven, Faculty of Medicine, Leuven, Belgium

Related article

by Niewada et al.,

see p. 510

Both European and American guidelines recommend cardiac rehabilitation (CR) as a priority in the secondary prevention and follow-up of both ischemic heart disease as heart failure [1, 2]. Despite the clear benefits of CR, the participation rates are disappointingly low across the globe [3]. Cardiac telerehabilitation and home-based CR are often considered as novel methods to increase adherence and participation. However, it is currently not proven that providing cardiac telerehabilitation can increase participation rates. On the other hand, it is well-established in multiple (small sample size) trials that telerehabilitation could be as effective as center-based CR with similar healthcare costs [4]. It is important to recognize that almost all previous studies used different models of cardiac telerehabilitation, and cost-effectiveness studies are rare.

Telerehabilitation models can have a hybrid approach where patients first start with center-based CR for several sessions and then start with a telerehabilitation program [5]. Other studies have examined the effectiveness of a combination of center-based CR and telerehabilitation [6]. The third approach is replacing center-based CR with telerehabilitation [7]. For all these telerehabilitation models, studies have shown that the results are non-inferior in comparison with standard care, but no study compared the different models [5–7]. The way of delivering cardiac telerehabilitation can have a significant impact on the effectiveness and especially on the costs [4]. Two methods of delivery can be distinguished synchronous and asynchronous. Synchronous cardiac telerehabilitation refers to real-time interaction between the patient and healthcare provider. This has the advantage of very close follow-up and better personalization. However, it is also associated with a higher workload for the healthcare professionals and therefore also higher costs, especially when providing individual synchronous cardiac telerehabilitation. This type of telerehabilitation is therefore probably best indicated in high-risk populations such as heart failure. In asynchronous telerehabilitation, there is no real-time interaction or follow-up between the patient and healthcare providers. Patients send their data to the hospital and are only monitored intermittently at fixed moments or if alerts occur. The advantage of asynchronous monitoring is that it is less labor-extensive and less costly providing the opportunity to follow-up large groups of patients simultaneously. However, most studies using this approach focused on stable low-risk patients.

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