Cardiac Rehab During COVID-19: Flexing to a Pandemic

The impact of the coronavirus (COVID-19) felt like an aftershock of a large-scale earthquake across the globe last year. Health care facilities scrambled to care for patients virtually to minimize exposure to the life-threatening virus. Perhaps this Benjamin Franklin quote is most pertinent to the times: “change is the only constant in life, but the ability to adapt to those changes will determine our success.” If the majority of the population was not resilient before 2020, perhaps resilience became a learned trait before the year’s end.

Cardiac rehabilitation (cardiac rehab) was one of many healthcare venues that required a viable alternative to traditional care in light of the COVID-19 pandemic. Cardiac rehabilitation is customarily an outpatient service in which participants attend a medically supervised exercise program for at least 3 sessions a week. It simultaneously incorporates lifestyle counseling for secondary prevention measures. In response to the pandemic, many centers closed their doors. While cardiac rehab is an invaluable prevention tool to reduce the risk for cardiovascular mortality and morbidity, the disruption in outpatient-based cardiac rehab increased the urgency to make adaptations for continued care in the home setting.1

Home-based cardiac rehab, also referred to as virtual cardiac rehab, is a formidable process to implement. It was recently instituted in Australia, Canada, and the United Kingdom to reduce barriers to the standard in-person model and improve access.2,3 Virtual cardiac rehab, similar to traditional outpatient models, implements core elements of cardiac rehab that patients can regularly employ in the home. These components are further supported by the health care team via video applications, electronic mail or messaging, or telephonic follow-up.1,2,4,5,6,7 The following are included during each session:

  • A comprehensive patient assessment
  • EKG monitoring (equipment provided by the health care team)
  • Dietary and exercise counseling
  • In the home setting, walking is most often recommended while telephonic support is provided to the individual.

During the telephonic support sessions, risk factor modification is reviewed including, the use of tobacco and alcohol, stress management, and diet and exercise routines. For telehealth strategies for cardiovascular nurses, see our recent article.

Although there was no significant difference found between the standard outpatient cardiac rehab and the virtual cardiac rehab setting for 30-day readmission, virtual cardiac rehab offers a cost-effective approach affording patients flexibility, preserved care delivery, and reduced delays in care after a cardiac event.1,3

As the country hopes to see the end of the pandemic in the current calendar year, certain changes in post-pandemic healthcare modalities of virtual medicine may be found to be beneficial and successful. Evidence supports that virtual cardiac rehab can be achieved at home and on par with the traditional outpatient model. Moreover, virtual cardiac rehab requires only the employment of technology that patients utilize daily, along with regular follow-up support from the health care team to guide lifestyle habits and encourage risk factor modification.

References

  1. Drwal, K. R., Forman, D. E., Wakefield, B. J., & El Accaoui, R. N. (2020). Cardiac Rehabilitation During COVID-19 Pandemic: Highlighting the Value of Home-Based Programs. Telemedicine and E-Health, 26(11).
  2. Moulson, N., Bewick, D., Selway, T., Harris, J., Suskin, N., Oh, P., Coutinho, T., Singh, G., Chow, C.-M., Clarke, B., Cowan, S., Fordyce, C. B., Fournier, A., Gin, K., Gupta, A., Hardiman, S., Jackson, S., Lamarche, Y., Lau, B., & Légaré, J.-F. (2020). Cardiac Rehabilitation During the COVID-19 Era: Guidance on Implementing Virtual Care. Canadian Journal of Cardiology, 36(8).
  3. Thomas, R. J., Beatty, A. L., Beckie, T. M., Brewer, L. C., Brown, T. M., Forman, D. E., Franklin, B. A., Keteyian, S. J., Kitzman, D. W., Regensteiner, J. G., Sanderson, B. K., & Whooley, M. A. (2019). Home-Based Cardiac Rehabilitation. Journal of the American College of Cardiology, 74(1), 133–153.
  4. European Society of Cardiology. (2020, April 8). Recommendations on how to provide cardiac rehabilitation activities during the COVID-19 pandemic.
  5. Johns Hopkins Medicine. (2021, February 1). Telemedicine and Cardiac Rehabilitation.
  6. Nakayama, A., Takayama, N., Kobayashi, M., Hyodo, K., Maeshima, N., Takayuki, F., Morita, H., & Komuro, I. (2020). Remote cardiac rehabilitation is a good alternative of outpatient cardiac rehabilitation in the COVID-19 era. Environmental Health and Preventive Medicine, 25(1).
  7. Pecci, C., & Ajmal, M. (2021). Cardiac Rehab in the COVID-19 Pandemic. The American Journal of Medicine, 7(1).

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