Telemedicine in cardiac rehabilitation--a literature review and critical appraisement

The propagation of telemedicine has influenced the development of cardiac rehabilitation as well. Especially on an outpatient basis, there is an increasing number of publications about exercise training at home controlled by telemedical ECG. These trials, however, are predominantly feasibility studies including only few patients. In addition, most of the patients were male, classified as uncomplicated low-risk patients, and the vast majority was not included until weeks and months after the acute event. So far, there is no randomized controlled trial about telemedicine in cardiac rehabilitation in a large representative population. Furthermore, in most of the studies, only telemedically conducted exercise training was evaluated, and education classes as well as psychosocial interaction with the multidisciplinary team were not considered. The argument most often cited for the further spread of telemedicine, i.e. that its use will reduce the costs of medical care, has been proven so far neither. In conclusion, telemedical supervision of exercise training at home is technically feasible. As controlled data are lacking, risks and benefits of telemedical interventions in cardiac rehabilitation are not well evaluated yet. By no means may the sole telemedically supervised exercise training at home replace the multidisciplinary cardiac rehabilitation on an in- or outpatient basis. However, as there is the great opportunity to facilitate access to cardiac rehabilitation programmes for patients living in rural areas as well, the application of telemedical techniques should be further evaluated scientifically in this setting giving special attention to cost-effectiveness in times of limited financial resources.