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Review
. 2023 Nov;53(11):727-743.
doi: 10.4070/kcj.2023.0242.

Remote Cardiac Rehabilitation With Wearable Devices

Atsuko Nakayama  1   2 , Noriko Ishii  3 , Mami Mantani  3 , Kazumi Samukawa  3 , Rieko Tsuneta  3 , Megumi Marukawa  4 , Kayoko Ohno  4 , Azusa Yoshida  5 , Emiko Hasegawa  5   6 , Junko Sakamoto  7 , Kentaro Hori  7 , Shinya Takahashi  8 , Kaoruko Komuro  1   9 , Takashi Hiruma  1   10 , Ryo Abe  1   10 , Togo Norimatsu  1   11 , Mai Shimbo  1   12 , Miyu Tajima  1   10 , Mika Nagasaki  1   13 , Takuya Kawahara  14 , Mamoru Nanasato  1 , Toshimi Ikemage  3 , Mitsuaki Isobe  15
Affiliations
Review

Remote Cardiac Rehabilitation With Wearable Devices

Atsuko Nakayama et al. Korean Circ J. 2023 Nov.

Abstract

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients' busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as cost-effectiveness and insurance coverage still persist.

Keywords: Cardiac rehabilitation; Remote medicine; Wearable devise.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1. Classical remote heart management for patients with heart failure. A remote device is installed in a patient’s home and monitored by a doctor, nurse, or other healthcare professional.
ECG = electrocardiogram.
Figure 2
Figure 2. Recent remote heart management for cardiovascular patients. Remote devices are becoming increasingly sophisticated, smaller, and less expensive. Vital information during exercise at home was transferred to the medical center, which was then used by a multidisciplinary team for intervention.
ECG = electrocardiogram; HR = heart rate; PHR = personal health record; SaMD = Software as a Medical Device.
Figure 3
Figure 3. Comparison between ergometer device and wearable device for remote exercise monitoring. Two typical remote devices were compared: ergometers and wearable watches.
Figure 4
Figure 4. Software as a Medical Device for remote cardiac rehabilitation. Health apps are intangible, but are recognized as medical devices and can be used as monitors, programs, communication tools, and personal health data gatherers.
Figure 5
Figure 5. Flowchart of remote heart management by a multi-disciplinary team. A flow of telenursing and multi-professional interventions must be developed in advance to collect data efficiently.
CPET = cardiopulmonary exercise testing; CR = cardiac rehabilitation; IC = informed consent.
See this image and copyright information in PMC

References

    1. Goto Y. Current state of CR in Japan. Prog Cardiovasc Dis. 2014;56:557–562. - PubMed
    1. Nakayama A, Nagayama M, Morita H, Kawahara T, Komuro I, Isobe M. The use of geographical analysis in assessing the impact of patients’ home addresses on their participation in outpatient CR: a prospective cohort study. Environ Health Prev Med. 2020;25:76. - PMC - PubMed
    1. De Vos C, Li X, Van Vlaenderen I, et al. Participating or not in a CR programme: factors influencing a patient’s decision. Eur J Prev Cardiol. 2013;20:341–348. - PubMed
    1. Ghisi GL, Kin SM, Price J, et al. Women-focused cardiovascular rehabilitation: an International Council of Cardiovascular Prevention and Rehabilitation clinical practice guideline. Can J Cardiol. 2022;38:1786–1798. - PubMed
    1. Ministry of Health, Labour and Welfare (JP) Overview of the 2021 medical facilities (dynamic) survey and hospital report [Internet] Tokyo: Ministry of Health, Labour and Welfare; 2022. [cited 2023 October 12]. Available from: https://www.mhlw.go.jp/toukei/saikin/hw/iryosd/21/index.html.