Korean Circ J.  2023 Nov;53(11):727-743. 10.4070/kcj.2023.0242.

Remote Cardiac Rehabilitation With Wearable Devices

• Nakayama A
• Ishii N
• Mantani M
• Samukawa K
• Tsuneta R
• Marukawa M
• Ohno K
• Yoshida A
• Hasegawa E
• Sakamoto J
• Hori K
• Takahashi S
• Komuro K
• Hiruma T
• Abe R
• Norimatsu T
• Shimbo M
• Tajima M
• Nagasaki M
• Kawahara T
• Nanasato M
• Ikemage T
• Isobe M

• KMID: 2548235
• DOI: http://doi.org/10.4070/kcj.2023.0242

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 costeffectiveness and insurance coverage still persist.

Keyword

Remote medicine; Cardiac rehabilitation; Wearable devise

Figure

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  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.

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  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.

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  Figure 3 Comparison between ergometer device and wearable device for remote exercise monitoring. Two typical remote devices were compared: ergometers and wearable watches.

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  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.

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  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.

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