Ensweet and MyTwin: keeping cardiac rehabilitation going at home

The benefits of cardiac rehabilitation are established. A Cochrane review of 85 trials and 23,430 people found that exercise-based rehabilitation may lead to a large reduction in cardiovascular deaths and heart attacks over the long term. European guidelines give it their highest level of recommendation, while noting that referral, participation and implementation rates remain low.

The numbers bear that out. In a survey of 4,548 patients across 14 countries, only one in three had been advised to take part in a rehabilitation programme, and one in five attended at least half of the sessions.

Valentine Antoine describes the same barriers in France: rehabilitation centres that are few and unevenly spread, waits of several months for a place, and younger patients who can’t leave work and family for weeks.

Ensweet’s model is hybrid. The patient starts at the rehabilitation centre, with an exercise test and interviews. If the care team agrees, the programme continues at home for three to four weeks, designed and followed by the same team:

• an exercise bike and a heart-rate sensor are delivered to the patient’s home;
• heart rate is monitored during each session, with an alert above a safety limit set by the care team;
• the programme combines adapted physical activity with education on diet, smoking and alcohol;
• the care team follows the sessions through a web interface, and the patient through a mobile app, according to Ensweet.

Tele-rehabilitation with Ensweet has been tested in real-life conditions in 23 French healthcare facilities, through two experiments under “Article 51”, France’s scheme for testing innovative care pathways. Ensweet states that its software is a class I medical device.

Does rehabilitation at home work as well as in a centre? A Cochrane review found that home-based programmes, with or without digital platforms, and centre-based ones seem similarly effective when supported by healthcare staff, though the certainty of the evidence is often low. And, as Valentine Antoine stresses, it is the care team that decides which path suits each patient.

Rehabilitation ends; the heart condition doesn’t. Keeping up physical activity and healthy habits in the months that follow is the hard part. That is where Ensweet wants to go next, with post-rehabilitation programmes, and where MyTwin comes in: a place where follow-up continues, and where patients and their doctors can find out that such programmes exist. A solution nobody knows about helps nobody, as Valentine Antoine puts it.

According to Valentine Antoine, Ensweet also plans a clinical study of a fully digital pathway for milder cases, and a move toward prevention before any cardiac event, the side our article on workplace heart health covers.