The first national program of remote cardiac rehabilitation in Israel – goal achievements, adherence, and responsiveness in elderly patients (Preprint)

BACKGROUND Remote cardiac rehabilitation (RCR) after myocardial infarction is an innovative Israeli national program in the field of tele-cardiology. RCR is included in the Israeli health coverage for all citizens. It is generally accepted that telemedicine programs better apply to younger patients, because it is thought that they are more technologically literate than older patients. It has also previously been thought that older patients have difficulty utilizing technology-based programs and attaining program goals. OBJECTIVE The objectives of this study were as follows: 1) To study patterns of physical activity, goal achievement, and improvement in functional level among RCR patients over 65 compared to younger patients and 2) To identify predictors of better adherence with the RCR program. METHODS A retrospective study of post-myocardial infarction patients were enrolled in a six-month RCR program. The activity of the patients was monitored using a smartwatch. The data was collected and analyzed by a special telemedicine platform. RCR program goals were: (i) 150 minutes of aerobic activity per week; (ii) 120 minutes of the activity in the target heart rate recommended by the exercise physiologist; (iii) 8,000 steps per day. Models were created to evaluate variables predicting adherence with the program. RESULTS Out of 306 patients, 80 of them were elderly (average age 70 ± 3.38). At the end of the program, there was a significant improvement in the functional capacity of all patients (P < .001). Specifically, the elderly group improved from 8.11 ± 2.8 to 11.25 ± 12.6 METs and their final METs results were similar to younger patients. During the entire program period, the elderly group showed better achievement of program goals compared to younger patients (P < .01). Additionally, we found that younger patient age is an independent predictor of early dropout from the program and completion of program goals (P < .01); younger patients were more likely to experience early program dropout as well as complete fewer program goals. CONCLUSIONS Elderly patients can not only successfully participate in telemedicine rehabilitation programs but derive significant benefit. We found that older age is not a limitation, but instead a predictor of better RCR program compliance as well as program goals achievement.