Key features in telehealth-delivered cardiac rehabilitation required to optimize cardiovascular health in coronary heart disease: a systematic review and realist synthesis

Victor M Gallegos-Rejas; Jonathan C Rawstorn; Robyn Gallagher; Ray Mahoney; Emma E Thomas

doi:10.1093/ehjdh/ztad080

Key features in telehealth-delivered cardiac rehabilitation required to optimize cardiovascular health in coronary heart disease: a systematic review and realist synthesis

Eur Heart J Digit Health. 2024 Jan 5;5(3):208-218. doi: 10.1093/ehjdh/ztad080. eCollection 2024 May.

Authors

Victor M Gallegos-Rejas^{1

2}, Jonathan C Rawstorn³, Robyn Gallagher⁴, Ray Mahoney^{5

6}, Emma E Thomas^{1

2}

Affiliations

¹ Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
² Centre for Health Services Research, The University of Queensland, Brisbane, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
³ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia.
⁴ Susan Wakil School of Nursing and Midwifery, The University of Sydney, Western Ave, Camperdown, NSW 2050, Australia.
⁵ CSIRO Health & Biosecurity, Australian e-Health Research Centre, Surgical, Treatment and Rehabilitation Service-STARS Level 7, 296 Herston Rd, Herston 4029, Australia.
⁶ School of Public Health, The University of Queensland, Brisbane, Australia.

Abstract

Telehealth-delivered cardiac rehabilitation (CR) programmes can potentially increase participation rates while delivering equivalent outcomes to facility-based programmes. However, key components of these interventions that reduce cardiovascular risk factors are not yet distinguished. This study aims to identify features of telehealth-delivered CR that improve secondary prevention outcomes, exercise capacity, participation, and participant satisfaction and develop recommendations for future telehealth-delivered CR. The protocol for our review was registered with the Prospective Register of Systematic Reviews (#CRD42021236471). We systematically searched four databases (PubMed, Scopus, EMBASE, and Cochrane Database) for randomized controlled trials comparing telehealth-delivered CR programmes to facility-based interventions or usual care. Two independent reviewers screened the abstracts and then full texts. Using a qualitative review methodology (realist synthesis), included articles were evaluated to determine contextual factors and potential mechanisms that impacted cardiovascular risk factors, exercise capacity, participation in the intervention, and increased satisfaction. We included 37 reports describing 26 randomized controlled trials published from 2010 to 2022. Studies were primarily conducted in Europe and Australia/Asia. Identified contextual factors and mechanisms were synthesized into four theories required to enhance participant outcomes and participation. These theories are as follows: (i) early and regular engagement; (ii) personalized interventions and shared goals; (iii) usable, accessible, and supported interventions; and (iv) exercise that is measured and monitored. Providing a personalized approach with frequent opportunities for bi-directional interaction was a critical feature for success across telehealth-delivered CR trials. Real-world effectiveness studies are now needed to complement our findings.

Keywords: Cardiac rehabilitation; Realist review; Secondary prevention; Systematic review; Telehealth.

Publication types

Review