Pengaruh Program Kombinasi Telerehabilitasi Kardiovaskular Terhadap Kemampuan Latihan Maksimal Pada Pasien Sindrom Koroner Akut Pasca Intervensi Koroner Perkutan

Aditya Doni Pradana, dr. Anggoro Budi Hartopo, M.Sc, Sp.PD(K), Ph.D, Sp.JP(K); Dr. Med. dr. Putrika Prastuti Ratna Gharini, Sp.JP(K)

2025 | Tesis-Spesialis | ILMU PENYAKIT JANTUNG DAN PEMBULUH DARAH

Latar Belakang: Program rehabilitasi kardiovaskular berbasis latihan fisik pada pasien sindrom koroner akut (SKA) pasca intervensi koroner perkutan (IKP) terbukti aman dan efektif meningkatkan kemampuan latihan. Home-Based Cardiac Rehabilitation (HBCR) dan kombinasi rumah sakit sama amannya dengan Center-Based Cardiac Rehabilitation (CBCR). Home-Based Cardiac Telerehabilitation (HBCTR) merupakan suatu langkah inovasi terbaru program rehabilitasi kardiovaskular berbasis rumah yang memanfaatkan kemajuan teknologi. Penelitian menggunakan kombinasi telerehabilitasi berbasis smartwatch pada pasien SKA pasca IKP belum pernah dilakukan di Indonesia.

Tujuan: Penelitian ini merupakan uji pre-experimental-posttest with control dengan kelompok kontrol untuk mengetahui efek pengaruh program kombinasi telerehabilitasi kardiovaskular terhadap kemampuan latihan pasien SKA pasca IKP yang dinilai dengan uji latih jantung (ULJ) maksimal berbasis treadmill (TMT).

Metode: Total 45 subjek pasien SKA pasca IKP, stratifikasi risiko rendah-sedang, jarak tempuh entry test >100 m, secara berurutan dibagi menjadi kelompok berbasis CBCR (kontrol) (n = 23) dan kelompok kombinasi telerehabilitasi (perlakuan) (n = 22). Kedua kelompok mendapatkan program latihan berbasis rumah sakit 2x/minggu selama 4 minggu, intensitas sedang, durasi 30 menit setiap sesi. Kelompok perlakuan mendapat latihan aerobik 3-5x/minggu di rumah dengan supervisi telemonitor berbasis smartwatch. Luaran yang dinilai adalah hasil ULJ TMT pada akhir minggu ke-4 sebagai penanda kemampuan latihan maksimal. 

Hasil: Karakteristik dasar kedua kelompok secara umum tidak berbeda signifikan. Tidak terdapat perbedaan bermakna kemampuan latihan maksimal pasca rehabilitasi kardiovaskular pada kelompok perlakuan 10.2 (4.6-13.4) METs dan kontrol 8.5 (6.4-13.5) METs, p = 0.06 dan juga VO2 peak 35.7 (16.1-46.9) mL/kg/min vs. 29.7 (22.3-47.2) mL/kg/min, p = 0.06. Parameter lain seperti denyut jantung puncak latihan/HR peak) (p = 0.41) dan rate-pressure product/RPP (p=0.72) tidak didapatkan perbedaan secara signfikan. Tidak didapatkan potensi variabel lain yang berpengaruh secara signfikan (p>0.05) terhadap nilai kemampuan latihan maksimal.

Simpulan: Telerehabilitasi kardiovaskular dengan smartwatch terbukti memiliki efektivitas yang sama dengan CBCR dalam meningkatkan kemampuan latihan pasien SKA pasca IKP.

Background: Exercise-based cardiac rehabilitation programs in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) have been proven safe and effective in improving functional capacity. Home-Based Cardiac Rehabilitation (HBCR) and hybrid programs combining home and hospital components have demonstrated safety comparable to Center-Based Cardiac Rehabilitation (CBCR). Home-Based Cardiac Telerehabilitation (HBCTR) represents an innovative approach utilizing technological advancements to facilitate remote rehabilitation. To date, no studies in Indonesia have investigated the use of a smartwatch-based telerehabilitation program for ACS patients following PCI.

Objective: This pre-experimental–posttest study aimed to evaluate the effect of a combined home-based cardiovascular telerehabilitation program (HBCTR) on the exercise capacity of post-PCI ACS patients, assessed using treadmill-based maximal exercise testing (TMT).

Methods: A total of 45 post-PCI ACS patients with low-to-moderate risk and baseline entry test distance >100 meters were consecutively allocated into a CBCR (control) group (n = 23) and a HBCTR (intervention) group (n = 22). Both groups underwent supervised, moderate-intensity, hospital-based exercise sessions twice weekly for four weeks, with each session lasting 30 minutes. The intervention group additionally performed home-based aerobic exercise 3–5 times per week under smartwatch-based telemonitoring supervision. Outcomes were evaluated as TMT performance after four weeks of rehabilitation.

Results: Baseline characteristics were generally comparable between groups. There was no statistically significant difference in maximal exercise capacity after cardiovascular rehabilitation between the intervention group (10.2 [4.6–13.4] METs) and the control group (8.5 [6.4–13.5] METs), p = 0.06, nor in peak oxygen consumption (VO? peak) (35.7 [16.1–46.9] mL/kg/min vs. 29.7 [22.3–47.2] mL/kg/min, p = 0.06). Other parameters, such as peak exercise heart rate (HR peak) (p = 0.41) and rate-pressure product (RPP) (p = 0.72), did not show significant differences. No other variables were found to have a significant influence (p > 0.05) on maximal exercise capacity.

Conclusion: A smartwatch-assisted, home-based cardiovascular telerehabilitation demonstrated comparable effectiveness to conventional center-based cardiac rehabilitation in improving maximal exercise capacity among ACS patients after PCI.

Kata Kunci : acute coronary syndrome, exercise-based cardiac rehabilitation, telerehabilitation, exercise capacity, treadmill test