Building a hybrid virtual cardiac rehabilitation program to promote health equity: Lessons learned

Johnson, Trent; Isakadze, Nino; Mathews, Lena; Gao, Yumin; MacFarlane, Zane; Spaulding, Erin M; Martin, Seth S.; Marvel, Francoise A

doi:10.1016/j.cvdhj.2022.06.002

Cited by 8 publications

(9 citation statements)

References 11 publications

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“…In cardiovascular research, large-scale and long-term user involvement through a co-design process, can support adaption and lead of quicker adoption of digital health technologies 28 . Research groups are working and publishing in the human-centered design space 29 , thus, terminology related to co-design frameworks will likely emerge should this topic be re-analysed in the near future. On the other hand, with the global burden of CVD showing no signs of slowing, it is promising to see the frequency of clinical trials utilised in secondary prevention of CVD.…”

Section: Discussionmentioning

confidence: 99%

The evolution of digital health technologies in cardiovascular disease research

et al. 2023

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When implemented in practice, digital technologies have shown improvements in morbidity and mortality outcomes in patients with cardiovascular disease (CVD). For scholars, research into digital technologies in cardiovascular care has been relatively recent, thus it is important to understand the history of digital health technology in cardiovascular research—its emergence, rate of growth, hot topics, and its temporal evolution. The aim of this study was to analyse more than 16,000 articles in this domain based on their scientometric indicators. Web of Science (WoS) Core Collection was accessed and searched at several levels, including titles, abstracts, keywords, authors, sources and individual articles. Analysis examined the temporal shifts in research and scholarly focus based on keywords, networks of collaboration, topical divisions in relation to digital technologies, and influential publications. Findings showed this research area is growing exponentially. Co-citation analysis revealed twenty prominent research streams and identified variation in the magnitude of activities in each stream. A recent emergence of research activities in digital technology in cardiovascular rehabilitation (CR), out-of-hospital cardiac arrest (OHCA), and arrythmia research was also demonstrated. Conversely, wearable technologies, activity tracking and electronic medical records research are now past their peak of reported research activity. With increasing amounts of novel technologies becoming available and more patients taking part in remote health care monitoring, further evaluation and research into digital technologies, including their long-term effectiveness, is needed. Furthermore, emerging technologies, which are evaluated and/or validated should be considered for implementation into clinical practice as treatment and prevention modalities for CVD.

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Section: Discussionmentioning

confidence: 99%

The evolution of digital health technologies in cardiovascular disease research

et al. 2023

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“…Future studies should focus on making the technology transparent to both patients and healthcare professionals, allowing both to focus on the ultimate goal of improving the lives of cardiac patients. 83 …”

Section: Discussionmentioning

confidence: 99%

Virtual healthcare solutions for cardiac rehabilitation: a literature review

Lee

Breznen²,

Ukhova³

et al. 2023

European Heart Journal - Digital Health

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Aims Adherence to cardiac rehabilitation following a primary event has been demonstrated to improve quality of life, increase functional capacity, and decrease hospitalizations and mortality. Mobile technologies offer an opportunity to improve both the quality and utilization of cardiac rehabilitation and recent clinical studies investigated this technology. This literature review summarizes the current use of mobile health, wearable activity monitors, and other multi-component technologies deployed to support home-based virtual cardiac rehabilitation. Methods and results Methodology was adapted from the Cochrane Handbook for Systematic Reviews of Interventions. We identified 2,094 records, of which 113 were eligible for qualitative analysis. Different virtual cardiac rehabilitation solutions were implemented in the studies, (1) multi-component interventions in 48 studies (42.5%), (2) wearable activity monitors in 27 studies (23.9%), (3) web-based communications solutions, and (4) mobile apps, both in 19 studies (16.4%). Functional capacity was the most frequently reported primary outcome (k=37, 32.7%), followed by user adherence/compliance (k=35, 31.0%), physical activity (k=27, 23.9%), and quality of life (k=14, 12.4%). Studies provided a mixed assessment of the efficacy of virtual cardiac rehabilitation in attaining either significant improvements over baseline, or significant improvements in outcomes compared with conventional rehabilitation. Conclusions Efficacy outcomes with virtual cardiac rehabilitation sometimes improve on the centre-based outcomes, however, superior clinical efficacy may not necessarily be the only outcome of interest. The promise of virtual cardiac rehabilitation includes the potential for increased user adherence and longer-term patient engagement. If these outcomes can be improved, that would be a significant justification for using this technology.

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“…Additional challenges with regard to implementing digital technology in CR relate to onboarding and providing technology support to patients and clinicians. 42 Ensuring patient access to education and training on digital technology use will be necessary to avoid worsening health disparities (see subsequent section), to prevent exploitation of patients with low digital literacy, and to minimize patient and clinician anxiety and unnecessary downstream testing from alarms of unproven clinical value. Last, to ensure the fidelity of digital interventions implemented across sites of care, we favor standardized reporting of digital intervention studies.…”

Section: Methodsmentioning

confidence: 99%

“…A recent report provides an example of a stepwise approach to building a hybrid CR program using technology that promotes equitable access for patients with differing levels of digital literacy. 42 When properly designed, leveraging the lived experiences of an advisory panel of patients and caregivers, digital interventions can incorporate patient and caregiver voice and ensure that their perspectives are included in future CR programs using digital technologies. 49 The opportunity to use digital technologies in CR to address health equity challenges is immense.…”

Section: Equity In Digital Crmentioning

confidence: 99%

Digital Technologies in Cardiac Rehabilitation: A Science Advisory From the American Heart Association

Golbus¹,

López-Jiménez²,

Barac³

et al. 2023

Circulation

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Cardiac rehabilitation has strong evidence of benefit across many cardiovascular conditions but is underused. Even for those patients who participate in cardiac rehabilitation, there is the potential to better support them in improving behaviors known to promote optimal cardiovascular health and in sustaining those behaviors over time. Digital technology has the potential to address many of the challenges of traditional center-based cardiac rehabilitation and to augment care delivery. This American Heart Association science advisory was assembled to guide the development and implementation of digital cardiac rehabilitation interventions that can be translated effectively into clinical care, improve health outcomes, and promote health equity. This advisory thus describes the individual digital components that can be delivered in isolation or as part of a larger cardiac rehabilitation telehealth program and highlights challenges and future directions for digital technology generally and when used in cardiac rehabilitation specifically. It is also intended to provide guidance to researchers reporting digital interventions and clinicians implementing these interventions in practice and to advance a framework for equity-centered digital health in cardiac rehabilitation.

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Building a hybrid virtual cardiac rehabilitation program to promote health equity: Lessons learned

Cited by 8 publications

References 11 publications

The evolution of digital health technologies in cardiovascular disease research

The evolution of digital health technologies in cardiovascular disease research

Virtual healthcare solutions for cardiac rehabilitation: a literature review

Digital Technologies in Cardiac Rehabilitation: A Science Advisory From the American Heart Association

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