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The Influence of Hybrid Comprehensive Telerehabilitation on Anxiety in Heart Failure Patients: The TELEREH-HF Randomized Clinical Trial

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Abstract

Telerehabilitation for heart failure (HF) patients is beneficial for physical functioning, prognosis, and psychological status. The study aimed at evaluating the influence of hybrid comprehensive telerehabilitation (HCTR) on the level of anxiety in comparison to usual care (UC). The TELEREH-HF study was a multicenter prospective RCT in 850 clinically stable HF participants. Patients underwent clinical examinations, including the assessment of anxiety, at entry and after the 9-week training program (HCTR) or observation (UC). The State-Trait Anxiety Inventory (STAI) was used. 20.3% HCTR and 20.1% UC patients reported high level of anxiety as a state at baseline, with higher STAI results in younger participants (< 63 y.o.) (p = .048 for HCTR; p = .026 for UC). At both stages of the study, patients with lower level of physical capacity (measured by a peak VO2) had shown significantly higher level of anxiety. There were no significant changes in anxiety levels during the 9-week observation for the entire study population, although there were different patterns of change in anxiety (both trait and state) in younger and older groups,with the decrease in younger patients, and the increase—in the older group.

Trial registry number NCT 02523560 (Clinical Trials.gov), date of registration: August 14, 2015.

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Data Availability

De-identified data from this study are not available in an a public archive. De-identified data from this study will be made available (as allowable according to institutional IRB standards) by emailing the corresponding author. Materials used to conduct the study are not publicly available.

Code Availability

Analytic code used to conduct the analyses presented in this study are not available in a public archive. They may be available by emailing the corresponding author.

Abbreviations

ACC:

American College of Cardiology

AHA:

American Heart Association

BDI-II:

Beck Depression Inventory II

CIED:

Cardiovascular implantable electronic device

CPET:

Cardiopulmonary exercise test

CR:

Comprehensive cardiac rehabilitation

CVD:

Cardiovascular disease

ESC:

European Society of Cardiology

HCTR:

Hybrid comprehensive cardiac telerehabilitation

HF:

Heart failure

HR-QoL:

Health-related quality of life

LVEF:

Left ventricular ejection fraction

NYHA:

New York Heart Association

Peak VO2 :

Peak oxygen consumption

STAI:

Spielberger State-Trait Anxiety Inventory

UC:

Usual care

6MWT:

6 minute walk test

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

nsVT:

Nonsustained ventricular tachycardia

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Acknowledgements

The authors thank all the medical and technology members of the Telerehabilitation in Heart Failure Patients team for their valuable input into conducting the TELEREH-HF project.

Funding

The study was supported by the National Centre for Research and Development, Warsaw, Poland (Grant STRATEGMED1/233547/13/NCBR/2015). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. National Institute of Cardiology, 04-628, Warsaw, Poland

    Anna Mierzyńska, Ryszard Piotrowicz & Ilona Kowalik

  2. Department of Cardiac Surgery, Military Institute of Medicine – National Research Institute, 04-141, Warsaw, Poland

    Anna Mierzyńska

  3. Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Silesian Medical University, 41-800, Zabrze, Poland

    Izabela Jaworska

  4. College of Rehabilitation, 01-234, Warsaw, Poland

    Ryszard Piotrowicz

  5. Duke University’s School of Medicine, Durham, NC, 27710, USA

    Michael Pencina

  6. 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091, Warsaw, Poland

    Grzegorz Opolski & Renata Główczynska

  7. University of Rochester Medical Center, Rochester, NY, 14642, USA

    Wojciech Zareba

  8. Department of Hypertension, Medical University of Łódź, 90-419, Łódź, Poland

    Maciej Banach

  9. Telecardiology Center, National Institute of Cardiology, 04-628, Warsaw, Poland

    Piotr Orzechowski & Ewa Piotrowicz

  10. Department of Rehabilitation Medicine, Medical University of Gdańsk, 80-210, Gdańsk, Poland

    Dominika Szalewska

  11. Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Silesian Medical University, 41-800, Zabrze, Poland

    Sławomir Pluta & Zbigniew Kalarus

  12. Department of Internal Medicine and Cardiac Rehabilitation, Medical University of Łódź, 90-419, Łódź, Poland

    Robert Irzmanski

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  1. Anna Mierzyńska
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  2. Izabela Jaworska
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by AM, IJ, IK, RP, IK, MP, GO, WZ, MB, PO, RG, DS, SP, ZK, RI, and EP. The first draft of the manuscript was written by AM, IJ, IK, and EP. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Anna Mierzyńska.

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Conflict of interest

Anna Mierzyńska, Izabela Jaworska, Ryszard Piotrowicz, Ilona Kowalik, Michael Pencina, Grzegorz Opolski, Wojciech Zareba, Maciej Banach, Piotr Orzechowski, Renata Główczynska, Dominika Szalewska, Sławomir Pluta, Zbigniew Kalarus, Robert Irzmanski, and Ewa Piotrowicz declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments and ethical standards of the institutional research committee. We received approval from the National Institute of Cardiology institutional review board.

Consent to Participate and Publication

Informed consent was obtained from all individual participants included in the study. No individual data or image is presented in the manuscript.

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Mierzyńska, A., Jaworska, I., Piotrowicz, R. et al. The Influence of Hybrid Comprehensive Telerehabilitation on Anxiety in Heart Failure Patients: The TELEREH-HF Randomized Clinical Trial. J Clin Psychol Med Settings 31, 403–416 (2024). https://doi.org/10.1007/s10880-023-09985-x

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