Remote-delivered cardiac rehabilitation during COVID-19: a prospective cohort comparison of health-related quality of life outcomes and patient experiences

Abstract

Aims Enforced suspension and reduction of in-person cardiac rehabilitation (CR) services during the coronavirus disease-19 (COVID-19) pandemic restrictions required rapid implementation of remote delivery methods, thus enabling a cohort comparison of in-person vs. remote-delivered CR participants. This study aimed to examine the health-related quality of life (HRQL) outcomes and patient experiences comparing these delivery modes. Methods and results Participants across four metropolitan CR sites receiving in-person (December 2019 to March 2020) or remote-delivered (April to October 2020) programmes were assessed for HRQL (Short Form-12) at CR entry and completion. A General Linear Model was used to adjust for baseline group differences and qualitative interviews to explore patient experiences. Participants (n = 194) had a mean age of 65.94 (SD 10.45) years, 80.9% males. Diagnoses included elective percutaneous coronary intervention (40.2%), myocardial infarction (33.5%), and coronary artery bypass grafting (26.3%). Remote-delivered CR wait times were shorter than in-person [median 14 (interquartile range, IQR 10–21) vs. 25 (IQR 16–38) days, P < 0.001], but participation by ethnic minorities was lower (13.6% vs. 35.2%, P < 0.001). Remote-delivered CR participants had equivalent benefits to in-person in all HRQL domains but more improvements than in-person in Mental Health, both domain [mean difference (MD) 3.56, 95% confidence interval (CI) 1.28, 5.82] and composite (MD 2.37, 95% CI 0.15, 4.58). From qualitative interviews (n = 16), patients valued in-person CR for direct exercise supervision and group interactions, and remote-delivered for convenience and flexibility (negotiable contact times). Conclusion Remote-delivered CR implemented during COVID-19 had equivalent, sometimes better, HRQL outcomes than in-person, and shorter wait times. Participation by minority groups in remote-delivered modes are lower. Further research is needed to evaluate other patient outcomes.

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

“…In keeping with findings by Candelaria et al and Huang et al, 29 30 our study showed that CR DHIs can significantly improve health related quality of life and anxiety and depression at EOP, with the majority of these changes being sustained at 6-month follow-up. These improvements can be attributed to the strong emphasis placed on addressing psychosocial health through group-based activities, stress management and psychological support.…”

Home-based cardiac rehabilitation for people with heart failure and their caregivers: a mixed-methods analysis of the roll out an evidence-based programme in Scotland (SCOT:REACH-HF study)

“…12 Our findings also echo the international body of literature showing that HRQoL improvements for people with HF engaging in home-based CR are similar to those participating in centrebased provision. 12,28 That the magnitude of improvement in total MLHF scores was not only statistically significant but also clinically meaningful, with a ≥5 point improvement in almost two-thirds of participants.…”

Exercise Self-efficacy Improvements During Cardiac Rehabilitation

“…It is important that these results are interpreted with caution, given that the effects of the COVID pandemic impacted patient willingness and preparedness to participate in the remote model of CR delivery. Remote methods of CR delivery may have been more appealing to those who were already self-motivated to exercise, whereas in-person sessions were preferred by patients who needed more support because of closer and direct instruction, guidance, and supervision 24. This proposition is supported by a study that examined motivation in patients participating in cardiac telerehabilitation versus traditional CR, which found that the traditional CR group was more likely to be dependent on external sources of motivation, such as health personnel, compared with the telerehabilitation group 47…”

“…We conducted a secondary analysis of data from a larger study of patient outcomes from CR, 24 which used a prospective observational design. Human Research Ethics and Research Governance Committee approval for all participating sites has been granted for this study (HREC Ref.…”