Feasibility and Effectiveness of Remote, Telephone-Based Delivery of Cardiac Rehabilitation

Wakefield, Bonnie J.; Drwal, Kariann; Scherubel, Melody; Klobucar, Thomas F.; Johnson, Skyler; Kaboli, Peter J.

doi:10.1089/tmj.2013.0079

Cited by 43 publications

(37 citation statements)

References 22 publications

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“…21,22,39,40 To our knowledge, only 1 randomized study previously investigated the use of the Internet for cardiac rehabilitation remotely, 23 which comprised online chats between patients and nurses/dietitians, online educational resources, and financial incentives for participation. After 6 months, there was no difference in exercise capacity and the only parameter to improve compared with the control group was weight reduction.…”

Section: Summary Of the Experience Futurementioning

confidence: 99%

Randomized Trial of a Virtual Cardiac Rehabilitation Program Delivered at a Distance via the Internet

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et al. 2014

Circ: Cardiovascular Quality and Outcomes

149

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With an aging population in many Western countries and increases in risk factors such as obesity, the number of patients with cardiovascular diseases (CVDs) is increasing. 1 These patients are at greater risk of subsequent events, comorbidities, and premature mortality, therefore effective and ongoing management is needed to reduce this risk. Cardiac rehabilitation programs (CRPs) are effective at improving lifestyle behaviors and reducing risk factors in patients with CVD, as well as reducing CVD events and premature mortality, while being cost-effective.2-5 As a result, the American Heart Association, and others, have highlighted participation in CRP as an essential element of secondary prevention in patients with CVD. [6][7][8] Despite the known benefits of CRP, as little as 10% to 30% of eligible patients attend these programs. [9][10][11][12][13] The majority of these programs are limited to hospitals in large urban areas with geographical accessibility as one of the main barriers to attendance.14,15 Lack of access is more pronounced for patients in rural areas that do not have CRP, 16,17 although risk factors such as smoking and obesity are higher in rural populations 18 resulting in a greater rate of hospitalizations than urban populations.19 Home-based CRP have been developed to address the accessibility issue, and a review of these studies found no difference to hospital-based CRP with respect to improvements in CVD risk. 20 However, these programs generally consist of a mix of on-site exercise sessions, clinic or home visits, telephone calls from staff, and diaries, which still require patients to attend some sort of clinic and therefore do not accommodate patients in outlying areas.The proliferation of low-cost communications technology, such as the Internet, has opened up an array of opportunities for patient communication while bridging geographic distance. The Internet holds great promise in improving access to healthcare services as it is ubiquitous, requires little infrastructure and cost, and is readily scalable to large populations. Despite the enthusiasm for technology supported healthcare services, the evidence to support such use in cardiac rehabilitation is limited to pilot studies. [21][22][23][24] As a result, a recent American Heart Association Presidential Advisory has called for more robust research to test the feasibility and effectiveness of Internet-based CRP. 25 Our goal therefore, was to test the clinical effectiveness of a virtual CRP (vCRP) delivered exclusively using Internet-based technology. Local Challenges in ImplementationA common challenge to the implementation of CRP is the cost of their implementation despite having been demonstrated to be cost-effective.5 This challenge also holds true for technology-based solutions. Although several communication technology mediums exist (telephone, video-conferencing, and telemonitoring), we chose to use a web-based program delivered through the Internet as it is (1) commonly available in people's homes, (2) requires less capital exp...

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Section: Summary Of the Experience Futurementioning

confidence: 99%

Randomized Trial of a Virtual Cardiac Rehabilitation Program Delivered at a Distance via the Internet

Lear

Singer

Banner

et al. 2014

Circ: Cardiovascular Quality and Outcomes

149

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“…This includes a study by Wakefield et.al, conducted in a Veteran population with a mean age of 63.7 ± 8.2 utilizing a remote, HBCR as well as periodic telephone calls. The study concluded that this model would not only bring CR services closer to patients, but noted participants were highly satisfied and had higher completion rates …”

Section: Hbcr With Telephonic Monitoringmentioning

confidence: 97%

“…The study concluded that this model would not only bring CR services closer to patients, but noted participants were highly satisfied and had higher completion rates. 32 Larger studies utilizing telephonic monitoring and mail contact with patients have shown to improve several coronary risk factors such as lipid profiles, activity, and smoking cessation, after acute myocardial infarction and the implementation of this could be useful for comprehensive CR. 33,34 In addition, in a study specifically following a CR program with telephone follow-ups found that the intervention resulted in a significantly improved Framingham score, total cholesterol, low-density lipoprotein cholesterol, and systolic blood pressure A randomized controlled trial also showed a significant benefit of digital health intervention when added to standard CR.…”

Section: Hbcr With Telephonic Monitoringmentioning

confidence: 99%

Cardiac rehabilitation in older adults: New options

Kumar

Piña

2019

Clinical Cardiology

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Cardiac rehabilitation (CR) is an important component in the continuum of care for patients with cardiovascular diseases, including the older population. Benefits of CR which include mortality benefit, decreased hospitalizations, increased functional capacity all extend to an older population. In Medicare beneficiaries which represent an older population, utilization of CR continues to remain low despite evidence that suggests lower hospitalization rates, Medicare costs, and improved symptoms. Given poor referral rates, enrollment rates, and completion rates, a call for new strategies has been made by all major societies. However, several barriers exist. Newer models of CR constructed to overcome these barriers are reviewed below. Some of these new strategies include alternative site CR or home‐based CR and the utilization of technology.

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“…47,48 A recent study found that a remote CR program delivered to patients via telemedicine had higher completion rates and comparable costs compared with in-clinic programs. 49 Moreover, Milani and Lavie 19 utilized health professionals qualified to deliver CR services (ie, nurses, dietitians, health educators, and exercise physiologists and psychologists) to operate a CR program in the workplace. In this study, there was a significant improvement in cardiovascular risk profiles and reduction in health care expenditures.…”

Section: Opportunities For Workite Cr Programsmentioning

confidence: 99%

The Affordable Care Act

Pinkstaff

Arena

Myers

et al. 2014

Journal of Occupational &Amp; Environmental Medicine

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Many people affected by cardiovascular disease (CVD) are working age. Employers bear a large percentage of the costs associated with CVD. Employers pay 80 times more in diagnosis and treatment than in prevention, although there is evidence that 50% to 70% of all diseases are associated with preventable health risks. As a result, the worksite is an appealing location to deliver health care.Cardiac rehabilitation has developed a track record of delivering improved outcomes for patients with CVD. Partnerships between cardiac rehabilitation providers and worksite health programs have the potential to improve referral and participation rates of employees with CVD. The current era of health reform in the United States that has been stimulated by the Affordable Care Act provides an ideal opportunity to reconsider worksite health programs as an essential partner in the health care team.

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Feasibility and Effectiveness of Remote, Telephone-Based Delivery of Cardiac Rehabilitation

Cited by 43 publications

References 22 publications

Randomized Trial of a Virtual Cardiac Rehabilitation Program Delivered at a Distance via the Internet

Randomized Trial of a Virtual Cardiac Rehabilitation Program Delivered at a Distance via the Internet

Cardiac rehabilitation in older adults: New options

The Affordable Care Act

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