Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era

Abstract

This Delphi consensus by 28 experts from the European Association of Preventive Cardiology (EAPC) provides initial recommendations on how cardiovascular rehabilitation (CR) facilities should modulate their activities in view of the ongoing coronavirus disease 2019 (COVID-19) pandemic. A total number of 150 statements were selected and graded by Likert scale [from −5 (strongly disagree) to +5 (strongly agree)], starting from six open-ended questions on (i) referral criteria, (ii) optimal timing and setting, (iii) core components, (iv) structure-based metrics, (v) process-based metrics, and (vi) quality indicators. Consensus was reached on 58 (39%) statements, 48 ‘for’ and 10 ‘against’ respectively, mainly in the field of referral, core components, and structure of CR activities, in a comprehensive way suitable for managing cardiac COVID-19 patients. Panelists oriented consensus towards maintaining usual activities on traditional patient groups referred to CR, without significant downgrading of intervention in case of COVID-19 as a comorbidity. Moreover, it has been suggested to consider COVID-19 patients as a referral group to CR per se when the viral disease is complicated by acute cardiovascular (CV) events; in these patients, the potential development of COVID-related CV sequelae, as well as of pulmonary arterial hypertension, needs to be focused. This framework might be used to orient organization and operational of CR programmes during the COVID-19 crisis.

COVID-19 and Cardiovascular Disease: a Global Perspective

“…As such, also the European Association of Preventive Cardiology has made a call for action for telerehabilitation in this difficult period [ 5 •], a position paper to overcome challenges in digital health implementation in cardiovascular medicine has been published by the ESC e-Cardiology Working Group [ 48 ••], and several national associations have published consensus papers on how to deliver a cardiac rehabilitation programme during this period [ 49 – 52 ]. Also the European Association of Preventive Cardiology has timely provided general recommendations for cardiac rehabilitation activities during the COVID-19 pandemic [ 53 ].…”

Development of a questionnaire set to evaluate adaptations to COVID era: The ICS TURNOVER project (Transition of fUnctional uRology to New COVID ERa)

“…5 A better way to obtain recommendations on COVID-19 adaptations would be to use a survey among specialists around the world. 6,7 We decided to take the Delphi methodology to devise the survey questionnaires for male/female lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP), chronic pelvic pain (CPP), and neurourological diseases in the crisis of COVID-19.…”

Exercise and sports after COVID‐19—Guidance from a clinical perspective

“…As exercise training has shown to have substantial beneficial effects and is recommended as standard therapy in pulmonary disease, for example, fibrosis or pulmonary hypertension, [15][16][17] heart failure, 18 kidney disease 19,20 as well sarcopenia, 21 exercise programs for post-COVID-19 patients are absolutely mandatory. 22,23 These patients have to be integrated into general rehabilitation programs, which also consider COVID-19-specific comorbidities. Exercise training should be supervised during the early phase of rehabilitation, for example, during in-hospital or in group exercises and can be added and later confined to non-supervised training in a home-based setting or in a fitness gym.…”