Patients with heart failure with reduced ejection fraction (HFrEF) without type 2 diabetes (T2D) experienced more pronounced improvements in ventilatory profile, physical performance, and gas exchange parameters from hybrid comprehensive telerehabilitation (HCTR) vs usual care (UC) than patients with HFrEF with T2D, according to a study published in Cardiovascular Diabetology.

Cardiopulmonary exercise testing (CPET) has been demonstrated to be useful for quantifying aerobic capacity and identifying levels of exercise tolerance in patients with cardiovascular disease, as well as for assessment of functional capacity, hemodynamic abnormalities, and exercise-induced arrhythmias. However, data are limited regarding the efficacy of HCTR on cardiopulmonary exercise capacity in patients with HFrEF with vs without diabetes.

Investigators designed the Telerehabilitation in Heart Failure Patients trial (TELEREH-HF) to assess the impact of 9 weeks of HCTR vs UC on cardiopulmonary exercise capacity in HFrEF patients with vs without T2D ( identifier: NCT02523560).

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Patients included had clinically stable HF with left ventricular ejection fraction <40% after a hospitalization for worsening HF within the past 6 months. Participants were randomly assigned to HCTR or UC. Patients in the HCTR group exercised 5 times weekly on treadmills (1 week in hospital followed by 8 weeks at home), with exercise training supervised by a medical team of physiotherapists, physicians, nurses, and a psychologist.

CPET was performed using a system consisting of a remote device for tele-electrocardiogram-monitoring, mobile phone, and monitoring center.

A total of 850 patients were randomly assigned 1:1 to the HCTR group or the UC group. Of the total enrolled patients, 34.2% (291 of 850) had T2D. Among the 425 HCTR participants, 385 underwent CPET twice pre- and post-telerehabilitation; 33.5% (129 of 385) had T2D (HCTR-T2D group) and 66.5% (256 of 385) did not (HCTR-non-T2D group). Among the 425 UC patients, 397 underwent CPET twice; 34.5% (137 of 397) had T2D (UC-T2Dgroup) and 65.5% (260 of 397) did not (UC-non-T2D group).

From baseline to 9 weeks, differences in cardiopulmonary parameters among T2D participants remained similar between HCTR and UC patients. However, among participants without T2D, the HCTR intervention was associated with greater exercise time changes than UC: 56.7 s (95% CI, 46.1-67.3 s) vs 13.6 s (95% CI, 3.2-24.1; P <.001). This resulted in a statistically significant interaction between participants with vs without T2D: the difference in exercise time changes between HCTR vs UC was 12.0 s (95% CI, −15.1 to 39.1 s) in the T2D subset and 43.1 s (95% CI, 24.0-63.0 s) in the non-T2D subset (P =.016).

Statistically significant differences in ventilation at rest between the T2D and non-T2D participants were also observed from the effect of HCTR vs UC: −0.34 L/min (95% CI, −1.60 to 0.91 L/min) in the T2D subset and 0.83 L/min (95% CI, −0.06 to 1.73 L/min) in the non-T2D subset (P =.0496); and in the ventilation/carbon dioxide slope: 1.52 (95% CI, −1.55 to 4.59) for the T2D subset vs −1.44 (95% CI, −3.64 to 0.77) for the non-T2D subset (P =.044).

These results suggest that the benefits of hybrid comprehensive telerehabilitation vs usual care was more pronounced in patients with HFrEF without T2D.


Główczyńska R, Piotrowicz E, Szalewska D, et al. Effects of hybrid comprehensive telerehabilitation on cardiopulmonary capacity in heart failure patients depending on diabetes mellitus: subanalysis of the TELEREH-HF randomized clinical trial. Cardiovasc Diabetol. Published online May 13, 2021. doi: 10.1186/s12933-021-01292-9

This article originally appeared on The Cardiology Advisor