Background /Methods: To examine the status of cardiac rehabilitation programs (CRPs) during COVID-19, a web-based questionnaire was completed by CRP managers from April 23 rd -May 14 th 2020. Results Overall, 114 representatives of 144 CRPs (79.1% of Canadian programs) responded. Of respondents, 41.2% (n=47) reported CRP closure; primary reasons were staff redeployment and facility closure (41% of 51 responses, both). Redeployment occurred in open-CRPs and closed-CRPs (30±34% and 47±38% of employees respectively;p=.05) and reduced hours in 17.8±31% and 22.5±33% of remaining employees;p=.56. Of open-CRPs, 84.8% accepted referrals for medically high-risk patients pre-COVID-19; falling to only 43.5% during-COVID-19;p<.001. There was a significant reduction in patients with cognitive/communication/mobility deficits being eligible to participate during-COVID-19. Of respondents, 57%-82.6% reported safety concerns for prescribing exercise to medically high-risk and vulnerable populations. CRPs transitioned from group-based to one-to-one delivery models; >80% by phone and/or e-mail. Any tele-rehabilitation (one-to-one/group) was also used by 32.7% and 43.5% of CRPs to deliver exercise and education respectively (mostly one-to-one). Resource barriers cited by open- and closed-CRPs were related to technology; no tele-rehabilitation, lack of equipment and patient access (35% of all barriers) while 25.3% of barriers were owing to greater demands on staff time. Conclusion Within 2-months of COVID-19 being declared a pandemic, 41.2% of CRPs were closed and almost half of employees redeployed. Less time-efficient one-to-one models of remote care mostly by phone/e-mail were adopted. Vulnerable populations were disproportionately affected becoming ineligible owing to safety concerns. Strategies to open closed-CRPs, admitting high risk/vulnerable populations, and offering group-based tele-rehabilitation should be a national priority. Brief Summary An increase in patients with complex cardiac conditions referred to cardiac rehabilitation programs (CRPs) is expected given delayed treatment and cardiac involvement related to COVID-19. Yet, ∼half of employees were redeployed and 41% of Canadian CRPs closed. There was a marked decrease in open-CRPs accepting referrals for high medical-risk and vulnerable patients. Developing policy that provides strategies to open closed-CRPs, admitting high risk/vulnerable populations, and offering group-based tele-rehabilitation should be a national priority.

Background Evidence supports establishing a continuum of care from stroke rehabilitation (SR) to cardiac rehabilitation programs (CRPs). It is not known to what extent people poststroke are being integrated. This study aimed to determine the proportion of CRPs that accept referrals poststroke, barriers/facilitators, and eligibility criteria. Methods A web-based questionnaire was sent to CRPs across Canada. Results Of 160 questionnaires sent, 114 representatives (71%) of 130 CRPs responded. Of respondents, 65% (n = 74) reported accepting people with a diagnosis of stroke and doing so for a median of 11 years, 11 offering stroke-specific classes and an additional 6 planning inclusion. However, 62.5% of CRPs reported that < 11 patients participated in the last calendar year despite 88.5% reporting no limit to the number they could enroll. Among CRPs, 25% accepted only patients with concurrent cardiac diagnoses, living in the community (47.8%), and without severe mobility (70.1%), communication (80.6%), or cognitive (85.1%) deficits. The 2 most influential barriers and facilitators among all CRPs were funding and staffing. The fourth greatest barrier was lack of poststroke referrals, and third to sixth facilitators were SR/CRP collaboration to ensure appropriate referrals (third) and to increase referrals (sixth), toolkits for prescribing resistance (fourth), and aerobic training (fifth). CRP characteristics associated with accepting stroke were a hybrid program model, a medium program size, and having a falls prevention component. Conclusions Most CRPs accept patients poststroke, but few participate. Therefore, establishing SR/CRP partnerships to increase appropriate referrals, using a toolkit to help operationalize exercise components, and allocating funding/resources to CRPs may significantly increase access to secondary prevention strategies.

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Purpose: This study determines barriers and facilitators to including people with lower limb amputation (LLA) in cardiovascular rehabilitation programmes (CRPs). Method: Canadian CRP managers and exercise therapists were invited to complete a questionnaire. Results: There were 87 respondents. Of the 32 CRP managers, 65.6% reported that people with LLA were eligible for referral but of these, 61.9% only accepted LLA with cardiac disease, and 38.1% only accepted them with ≥ 1 cardiovascular risk factor. CRP eligibility progressively decreased as mobility severity increased, with 94% of programmes accepting those with mild mobility deficits but only 48% accepting those with severe deficits. Among therapists in CRPs that accepted LLAs, 54.3% reported not having an LLA participant within the past three years. Among all responding therapists and managers who were also therapists ( n = 58), 43% lacked confidence in managing safety concerns, and 45%, 16%, and 7% lacked confidence in prescribing aerobic exercise to LLA with severe, moderate, and no mobility deficits respectively. There was a similar finding with prescribing resistance training. LLA-specific education had not been provided to any respondent within the past three years. The top barriers were lack of referrals (52.6%; n = 30) and lack of knowledge of the contraindications to exercise specific for LLA (43.1%; n = 31). Facilitators included the provision of a resistance-training tool kit (63.4%; n = 45), education on exercise safety (63.4%; n = 45), and indications for physician intervention/inspection (63.6%; n = 42). Conclusion: Most of the CRPs surveyed only accept people with LLA if they have co-existing cardiac disease or cardiovascular risk factors. Few people with LLA participate. Education on CRP delivery for LLAs is needed to improve therapists’ confidence and exercise safety.