Harnessing digital health to optimise the delivery of guideline-based cardiac rehabilitation during COVID-19: an observational study

Abstract

BackgroundThe COVID-19 pandemic accelerated the uptake of digital health interventions for the delivery of cardiac rehabilitation (CR). However, there is a need to evaluate these interventions.MethodsWe examined the impact of an evidence-based, digital CR programme on medical, lifestyle and psychosocial outcomes. Delivered by an interdisciplinary team of healthcare professionals, the core components of this 12-week programme included lifestyle modification, medical risk factor management, psychosocial and behavioural change support. To support self-management, patients were provided with a Fitbit, a home blood pressure (BP) monitor and an interactive workbook. Patients received access to a bespoke web-based platform and were invited to attend weekly, online group-based supervised exercise sessions and educational workshops. Outcomes were assessed at baseline, end of programme and at 6-month follow-up.ResultsOver a 3-month period, 105 patients (88% with coronary heart disease) were referred with 74% (n=77) attending initial assessment. Of these, 97% (n=75) enrolled in the programme, with 85% (n=64) completing the programme, 86% (n=55) of completers attended 6-month follow-up. Comparing baseline to end of programme, we observed significant improvements in the proportion of patients meeting guideline-recommended targets for physical activity (+68%, p<0.001), BP (+44%, p<0.001) and low-density lipoprotein cholesterol (+27%, p<0.001). There were significant reductions in mean weight (−2.6 kg, p<0.001). Adherence to the Mediterranean diet score improved from 5.2 to 7.3 (p<0.001). Anxiety and depression levels (Hospital Anxiety and Depression score) both reduced by more than 50% (p<0.001). The majority of these improvements were sustained at 6-month follow-up.ConclusionOutcomes from this study suggest that interdisciplinary digital CR programmes can be successfully implemented and help patients achieve guideline recommended lifestyle, medical and therapeutic targets.

Group-based cardiac telerehabilitation interventions and health outcomes in coronary patients: A scoping review

“…The studies varied in research designs, including 11 randomized controlled trials, [18][19][20]23,26,27,[30][31][32][33]35 five pilot studies, 21,24,25,28,36 two observational studies, 29,34 one case study, 22 one qualitative study, 37 one mixed-method study, 38 and one cross-sectional study. 39 The studies had been conducted in different locations: 11 of them in Europe, [18][19][20]22,28,31,[33][34][35][36]39 six in Asia, 23,24,29,30,32,37 three in Australia, [25][26][27] and two in North America. 21,38 The target population of 21 of the studies was coronary artery disease patients with heart failure and in one study coronary artery disease patients and the patients' partners.…”

“…Out of the 22 studies, a chat feature was primarily utilized as a means of delivering the intervention in 15 studies, 21,22,[24][25][26][27][29][30][31][32]34,35,[37][38][39] telemonitoring, 18,20,24,[28][29][30][32][33][34][35][36][37]39 and a virtual platform [21][22][23][24][25]28,[30][31][32]34,35,[37][38][39] were used in 14 studies, other mobile connections in 12 studies 18,19,23,24,28,29,[33][34][35]…”

“…18,20,23,25,26,31,32,34,35,[37][38][39] In two of the 22 studies, returning to work had been set as the goal. 25,35 Online platforms were used to empower patients to make progress toward their goal 34,37,39 and aimed at supporting patients in planning their coping. 21 The used chat feature was commonly text-based and synchronous, using two-way audio-visual communication that enabled interactions between all parties.…”

“…18,19,[21][22][23]26,27,29,31,33 In total, 11 studies used longer follow-up times. These included four studies with measurement points set at 6 months, 26,27,30,34 five studies with measurement points at 1 year, 18,19,29,31,33 one study with a measurement point at 2 years 29 and one study at 4 years. 33 Common strategies used to promote a healthy lifestyle included promoting behavioral changes.…”

“…33 Common strategies used to promote a healthy lifestyle included promoting behavioral changes. 21,23,32,34,38,39 Among those with a healthy lifestyle at the start of the intervention, all the patients in the cardiac telerehabilitation group continued to maintain their healthy lifestyle throughout the treatment. 23 Early recovery prior to the return to work increased motivation for change and supported sustaining long-term selfmanagement.…”