Phase III maintenance telerehabilitation in elderly patients with chronic heart failure and type 2 diabetes (TELEMECHRON study)

Background: Heart failure (HF) and type 2 diabetes (T2DM) are significant public health concerns. This study evaluated a 6-month home-based telemedicine program for older patients with combined HF and T2DM. The primary outcome was exercise tolerance evaluated at the 6-minute walk test (6MWT). Secondary outcomes included improvements in the physical activity profile (PASE), quality of life, clinical parameters, and biomarkers. Methods: Patients were randomized into an Intervention (IG) or a Control (CG) Group. The IG received teleassistance from a nurse case manager, including telemonitoring and an app for medication adherence and symptom reporting. The CG received the usual care. Results: 163 patients (84% male) were included 82 (71 ± 9 years) in the IG and 81 (74 ± 8 years) in the CG. After six months, the IG showed a mean increase of 12.4 meters (95% CI [1.7, 23.1]; p = 0.0168) in the distance walked at 6MWT, while the CG experienced a decrease of -22.4 meters (95% CI [-36, -8.9]; p = 0.0029), with a significant difference between groups of p = 0.0001. The PASE scores in the IG revealed a slight increase (p = 0.2914). Conversely, the CG significantly decreased their PASE scores (p = 0.0242), indicating a meaningful difference (p = 0.0164). No significant changes were observed in the quality-of-life questionnaires. Positive results were obtained on clinical parameters. Conclusions: The study proposed a home-based Phase III telerehabilitation program to help patients with HF and T2DM to maintain a healthy lifestyle. While technology can be complex for the elderly, its acceptance improves when seen as beneficial.