Telerehabilitation vs. centre-based cardiac rehabilitation after acute coronary syndrome: results of the pragmatic TELECOR randomized trial

AIMS: Cardiac rehabilitation (CR) improves cardiovascular outcomes after acute coronary syndrome (ACS), but access remains suboptimal. Telerehabilitation may overcome barriers, yet evidence from real-world, public health systems is limited. This randomized controlled trial study aimed to evaluate the effectiveness of a structured telerehabilitation programme compared with standard centre-based CR in patients after ACS, focussing on cardiovascular risk factor control and lifestyle adherence. METHODS AND RESULTS: TELECOR is a pragmatic, open-label, randomized trial conducted at a tertiary public hospital. Adults with recent ACS were randomized 1:1 to an 8 week structured telerehabilitation or a centre-based CR programme. The primary outcome was achievement of a composite target (≥4 of 7 predefined cardiovascular and lifestyle goals) at 8 weeks. Secondary outcomes included changes in functional capacity, medication adherence, quality of life, psychological status, satisfaction, and cardiovascular events at 6 months. A total of 129 patients were randomized (65 telerehabilitation, 64 centre-based). At 8 weeks, 86% of telerehabilitation vs. 79.7% of centre-based participants met the composite target (P = 0.37). At 6 months, this was 87% vs. 80.4% (P = 0.34). Both groups showed similar improvements in functional capacity (≈+1 metabolic equivalent of tasks), adherence (>84%), and satisfaction (>91/100). No between-group differences were observed in clinical events or psychological outcomes. CONCLUSION: In a real-world public hospital setting, telerehabilitation was non-inferior to conventional CR in achieving cardiovascular risk factor control and improving functional capacity. These results support the broader integration of digital CR models into routine secondary prevention care.