Effectiveness on Health and Well-Being of an eHealth-Based Rehabilitation Program in Older People With Acute Heart Failure and/or Acute Coronary Syndrome: The Flip Side of the DELPHIC Study

Abstract

Introduction: Frailty is a clinical syndrome highly prevalent among elderly individuals with cardiovascular disease and is characterized by a progressive decline in the physiological reserves of multiple organ systems. Preliminary evidence suggests that frailty may not represent an irreversible condition, raising the possibility that targeted interventions could improve resilience and potentially alter the course of the syndrome. Cardiac rehabilitation (CR) programs are established effective tools to improve cardiovascular prognosis and quality of life. However, few studies have explored the efficacy of eHealth, home-based CR interventions on frailty. The DELPHIC (elDerly hEart faiLure Prevention reHabilitation bIomarkers prognostiC) study was designed to evaluate the effectiveness on frailty status of an eHealth-based, home-delivered CR program in older adults with cardiovascular disease.

Objectives: Primary endpoint was to evaluate frailty, in terms of prevalence and mean Essential Frailty Toolset (EFT) score, after 3-6 months of follow-up. Secondary outcomes regarded other aspects of life measured by scales/scores as depression (Geriatric Depression Scale - GDS), nutrition (Mini Nutritional Assessment - MNA), quality of life (EuroQoL score), daily activity (Barthel index), therapeutic adherence (Morisky Medication Adherence Scale - MMAS) and comorbidities (Cumulative Illness Rating Scale - CIRS).

Methods: We designed a multicenter, randomized, parallel-group trial enrolling people ≥65 years recently hospitalized for acute heart failure and/or acute coronary syndrome. Participants were randomized 1:1 to an eHealth home-based tele-rehabilitation program or the usual care. Intervention program included 3 rehabilitation sessions per week, 1 weekly telephone consultation with a research nurse who remotely monitored patients' vital signs (i.e. weight, blood pressure and ECG), and 14 psychoeducational and nutritional sessions (7 with a psychologist and 7 with a nutritionist).

Results: 206 total patients were equally distributed to intervention or usual care. At the end of the follow-up, the prevalence of frailty was significantly lower in the intervention group than in the control group (2.6% vs 11.9%, p=0.04), accompanied by a significant reduction in the mean EFT score (p<0.01). Furthermore, Barthel index significantly increased in the intervention group than in control group (p=0.01). Psychoeducational intervention led to a significantly lower GDS (p<0.01) and higher EuroQol (p<0.01) in treated subjects, indicating an improved self-perceived quality of life. In addition, the nutritional/educational intervention had a positive and measurable effect on participants, resulting in a significantly increased MNA score compared with the control group (p<0.01).

Conclusions: Telemedicine represents a form of continuity of care, allowing patients to feel monitored and supported from their homes, thereby reducing the sense of abandonment that may follow hospital discharge. The opportunity to receive healthcare services at home may contribute to making patients feel more comfortable during the intervention. Furthermore, the involvement of caregivers, who are often excluded from hospital-based care settings, may be crucial in remote rehabilitation pathways, providing practical assistance and fostering greater engagement in the care process.