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Commentary

Vol. 20 No. 2 (2022): New Horizons: Innovation in Medicine

Effectiveness of Home-Based Cardiac Rehabilitation and Its Importance During COVID-19

DOI
https://doi.org/10.26443/mjm.v20i2.857
Submitted
February 13, 2021
Published
2022-04-19

Abstract

Cardiac rehabilitation is a secondary prevention and disease-management opportunity for individuals living with cardiovascular disease. The COVID-19 pandemic has caused postponements and cancellations for many health services, including 41% of cardiac rehabilitation programs in Canada. Cardiac rehabilitation effectively reduces the risk of mortality, morbidity, and hospitalizations in cardiac clients. Without access, individuals face challenges to improve their health, which places them at risk of adverse outcomes. This paper argues that transitioning to home-based cardiac rehabilitation programs during the pandemic is a reasonable strategy to meet the ongoing rehabilitation needs of cardiac patients. Home-based cardiac rehabilitation programs utilize limited hospital or clinic visits because the majority of exercise is performed at home through regular communication with a case manager. Programs utilize a variety of resources, including technology, to regularly monitor, educate, and counsel clients. The programs’ flexibility and convenience overcome many multi-level barriers which normally impede participants from accessing services. These programs have proven to be equally effective, if not more effective than centre-based programs, at improving mortality, cardiac events, exercise capacity and modifiable risk factors. Home-based programs are a valid alternative to support and protect a vulnerable population, especially those at high risk if diagnosed with COVID-19. Transitioning to a home-based platform may be a challenge, but the Canadian Cardiovascular Society has provided practical approaches to support programs. Adapting current plans and developing new ones, utilizing appropriate resources, having a conservative exercise program, monitoring clients, emphasizing education, being flexible, and enhancing safety are key steps for a successful transition.

References

  1. World Health Organization. WHO Director- Generals opening remarks at the media briefing on COVID-19 [Internet]. [Place unknown]: World Health Organization; 2020. [cited 2020 Dec 14]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.
  2. Wu Z, McGooan J. Characteristics of and Important Lessons From the Coronavirus Disease: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020 [cited 2021 Feb 6];323(13):1239-42. Available from: doi:10.1001/jama.2020.2648.
  3. Wang L, Wang Y, Ye D, Liu Q. Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence. Int J Antimicrob Agents. 2020 [cited 2021 Feb 6];55(6):105948. Available from: https://doi.org/10.1016/j.ijantimicag.2020.105948.
  4. Canada. COVID-19 pandemic guidance for the health care sector. [Internet]. [Place unknown]: Government of Canada; 2020. [cited 2021 Feb 6]. Available from: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/covid-19-pandemic-guidance-health-care-sector.html#a3.
  5. Marzolini S, Ghisi GM, Hébert A-A, Ahden S, Oh P. Cardiac Rehabilitation in Canada during COVID-19. CJC Open. 2020 [Internet]. [cited 2020 Dec 14]. Available from: doi: 10.1016/j.cjco.2020.09.021.
  6. Canadian Cardiovascular Society. Guidance from the CCS COVID-19 rapid response team- the new “virtual reality”: practical approaches to the delivery of cardiac rehabilitation care during the COVID-10 crisis [Internet]. [Place unknown]: Canadian Cardiovascular Society; 2020 [cited 2020 Dec 14]. Available from: https://ccs.ca/app/uploads/2020/12/Cardiac_Rehab_In_Covid_v2.4_Final_17_May_313.pdf.
  7. Moulson N, Bewick D, Selway T, Harris J, Suskin N, Oh P, et al. Cardiac Rehabilitation During the COVID-19 Era: Guidance on Implementing Virtual Care. Can J Cardiol [Internet]. 2020 [cited 2020 Dec 14];36(8):1317-21. Available from: doi: 10.1016/j.cjca.2020.06.006.
  8. Canadian Association of Cardiac Rehabilitation. Canadian Guidelines for Cardiac Rehabilitation and Cardiovascular Disease Prevention. 3rd ed. Winnipeg: Canadian Association of Cardiac Rehabilitation; 2009 [cited 2020 Dec 14].
  9. Cardiac Care Network. Standards for the Provision of Cardiovascular Rehabilitation in Ontario. Toronto: Cardiac Care Network; 2014 [cited 2020 Dec 14].
  10. Heart and Stroke Foundation. Cardiac Rehabilitation (Cardiac Rehab) [Internet]. [Place unknown]. Heart and Stroke Foundation; 2020 [cited 2021 Feb 6]. Available from: https://www.heartandstroke.ca/heart-disease/recovery-and-support/cardiac-rehabilitation.
  11. Grace SL, Turk-Adawi K, Santiago de Araujo Pio C, Alter DA. Ensuring Cardiac Rehabilitation Access for the Majority of Those in Need: A Call to Action for Canada. Can J Cardiol [Internet]. 2016 [cited 2020 Dec 14];32(10 Suppl 2):S358-S64. Available from: doi: 10.1016/j.cjca.2016.07.001.
  12. Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ [Internet]. 2010 [cited 2020 Dec 14];340:b5631. Available from: doi:10.1136/bmj.b5631.
  13. Ramadi A, Haennel RG, Stone JA, Arena R, Threlfall TG, Hitt E, et al. The sustainability of exercise capacity changes in home versus center-based cardiac rehabilitation. J Cardiopulm Rehabil Prev [Internet]. 2015 [cited 2020 Dec 14];35(1):21-8. Available from: doi:10.1097/HCR.0000000000000084.
  14. Gabelhouse J, Eves N, Grace SL, Reid RC, Caperchione CM. Traditional versus hybrid outpatient cardiac rehabilitation: A comparison of patient outcomes. J Cardiopulm Rehabil Prev [Internet]. 2018 [cited 2020 Dec 14];38(4):231-8. Available from: doi:10.1097/HCR.0000000000000253.
  15. Smith KM, McKelvie RS, Thorpe KE, Arthur HM. Six-year follow-up of a randomised controlled trial examining hospital versus home-based exercise training after coronary artery bypass graft surgery. Heart [Internet]. 2011 [cited 2020 Dec 14];97(14):1169-74. Available from: doi:10.1136/hrt.2010.202036.
  16. Anderson L, Sharp GA, Norton RJ, Dalal H, Dean SG, Jolly K, et al. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev [Internet]. 2017 [cited 2020 Dec 14];6:CD007130. Available from: doi: 10.1002/14651858.CD007130.pub4.
  17. Lear SA, Singer J, Banner-Lukaris D, Horvat D, Park JE, Bates J, et al. Randomized trial of a virtual cardiac rehabilitation program delivered at a distance via the Internet. Circ Cardiovasc Qual Outcomes [Internet]. 2014 [cited 2020 Dec 14];7(6):952-9. Available from: doi:10.1161/CIRCOUTCOMES.114.001230.
  18. Claes J, Buys R, Budts W, Smart N, Cornelissen VA. Longer-term effects of home-based exercise interventions on exercise capacity and physical activity in coronary artery disease patients: A systematic review and meta-analysis. Eur J Prev Cardiol [Internet]. 2017 [cited 2020 Dec 14];24(3):244-56. Available from: doi:10.1177/2047487316675823.
  19. Jin K, Khonsari S, Gallagher R, Gallagher P, Clark AM, Freedman B, Briffa T, Bauman A, Redfer J, Neubeck L. Telehealth interventions for the secondary prevention of coronary heart disease: A systematic review and meta-analysis. EJCN [Internet]. 2019 [cited 2020 Dec 14];18(4):260-71. Available from: Doi: 10.1177/1474515119826510.
  20. Canada. Report from the Canadian Chronic Disease Surveillance System: Heart Disease in Canada [Internet]. Ottawa: Public Health Agency of Canada; 2018. Available from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/report-heart-disease-Canada-2018.html. [Accessed 3rd January 2021].
  21. Kabboul NN, Tomlinson G, Francis TA, Grace SL, Chaves G, Rac V, et al. Comparative Effectiveness of the Core Components of Cardiac Rehabilitation on Mortality and Morbidity: A Systematic Review and Network Meta-Analysis. J Clin Med [Internet]. 2018 [cited 2020 Dec 14];7(12). Available from: doi:10.3390/jcm7120514.
  22. Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev [Internet]. 2016 [cited 2020 Dec 14];(1):CD001800. Available from: doi: 10.1002/14651858.CD001800.pub3.
  23. Martin BJ, Hauer T, Arena R, Austford LD, Galbraith PD, Lewin AM, et al. Cardiac rehabilitation attendance and outcomes in coronary artery disease patients. Circulation [Internet]. 2012 [cited 2020 Dec 14];126(6):677-87. Available from: doi:10.1161/CIRCULATIONAHA.111.066738.
  24. Sandesara PB, Dhindsa D, Khambhati J, Lee SK, Varghese T, O'Neal WT, et al. Reconfiguring Cardiac Rehabilitation to Achieve Panvascular Prevention: New Care Models for a New World. Can J Cardiol [Internet]. 2018 [cited 2020 Dec 14];34(10):S231-S9. Available from: doi: 10.1016/j.cjca.2018.07.013.
  25. Alter DA, Oh PI, Chong A. Relationship between cardiac rehabilitation and survival after acute cardiac hospitalization within a universal health care system. Eur J Cardiovasc Prev Rehabil [Internet]. 2009 [cited 2020 Dec 14];16(1):102-13. Available from: doi: 10.1097/HJR.0b013e328325d662.
  26. Grace SL, Bennett S, Ardern CI, Clark AM. Cardiac rehabilitation series: Canada. Prog Cardiovasc Dis [Internet]. 2014 [cited 2020 Dec 14];56(5):530-5. Available from: doi: 10.1016/j.pcad.2013.09.010.
  27. Shanmugasegaram S, Oh P, Reid RD, McCumber T, Grace SL. Cardiac rehabilitation barriers by rurality and socioeconomic status: A cross-sectional study. Int J Equity Health [Internet]. 2013 [cited 2020 Dec 14];12(1). Available from: https://doi.org/10.1186/1475-9276-12-72.
  28. Shanmugasegaram S, Oh P, Reid RD, McCumber T, Grace SL. A comparison of barriers to use of home- versus site-based cardiac rehabilitation. J Cardiopulm Rehabil Prev [Internet]. 2013 [cited 2020 Dec 14];33(5):297-302. Available from: doi: 10.1097/HCR.0b013e31829b6e81.
  29. Brual J, Gravely S, Suskin N, Stewart DE, Grace SL. The role of clinical and geographic factors in the use of hospital versus home-based cardiac rehabilitation. International Journal of Rehabilitation Research [Internet]. 2012 [cited 2020 Dec 14];35(3):220-6. Available from: doi:10.1097/MRR.0b013e328353e375.
  30. Piotrowicz E, Piotrowicz R. Cardiac telerehabilitation: current situation and future challenges. Eur J Prev Cardiol [Internet]. 2013 [cited 2020 Dec 14];20(S2):1-24. Available from: doi: 10.1177/2047487313487483c.
  31. Leung YW, Brual J, Macpherson A, & Grace SL. Geographic issues in cardiac rehabilitation utilization: A narrative review. Health and Place [Internet]. 2010 [cited 2020 Dec 14];16(6):1196-205. Available from: doi: 10.1016/j.healthplace.2010.08.004.
  32. Tran M, Pesah E, Turk-Adawi K, Supervia M, Lopez Jimenez F, Oh P, et al. Cardiac Rehabilitation Availability and Delivery in Canada: How Does It Compare With Other High-Income Countries? Canadian Journal of Cardiology [Internet]. 2018 [cited 2021 Apr 19];34:S252–S262. Available from: https://doi.org/10.1016/j.cjca.2018.07.413.
  33. Besnier F, Gayda M, Nigam A, Juneau M, Bherer L. Cardiac Rehabilitation During Quarantine in COVID-19 Pandemic: Challenges for Center-Based Programs. Arch Phys Med Rehabil [Internet]. 2020 [cited 2020 Dec 14];101(10):1835-8. Available from: doi: 10.1016/j.apmr.2020.06.004.
  34. Canada. Data Blog: Heart disease in Canada [Internet]. [Place unknown]: Government of Canada; 2018. [cited 2021 Feb 6]. Available from: https://health-infobase.canada.ca/datalab/heart-disease-blog.html. [Accessed 6th February 2021].
  35. Grace SL, Turk-Adawi KI, Contractor A, Atrey A, Campbell NRC, Derman W, et al. Cardiac Rehabilitation Delivery Model for Low-Resource Settings: An International Council of Cardiovascular Prevention and Rehabilitation Consensus Statement. Progress in Cardiovascular Diseases [Internet]. 2016 [cited 2020 Dec 14];59(3):303-22. Available from: doi:10.1016/j.pcad.2016.08.004.
  36. Higgins RO, Rogerson M, Murphy BM, Navaratnam H, Butler MV, Barker L, et al. Cardiac Rehabilitation Online Pilot: Extending Reach of Cardiac Rehabilitation. J Cardiovasc Nurs [Internet]. 2017 [cited 2020 Dec 14];32(1):7-13. Available from: doi:10.1097/JCN.0000000000000297.
  37. Pfaeffli Dale L, Whittaker R, Dixon R, Stewart R, Jiang Y, Carter K, et al. Acceptability of a mobile health exercise-based cardiac rehabilitation intervention: a randomized trial. J Cardiopulm Rehabil Prev [Internet]. 2015 [cited 2020 Dec 14];35(5):312-9. Available from: doi:10.1097/HCR.0000000000000125.
  38. Rawstorn JC, Gant N, Rolleston A, Whittaker R, Stewart R, Benatar J, et al. End Users Want Alternative Intervention Delivery Models: Usability and Acceptability of the REMOTE-CR Exercise-Based Cardiac Telerehabilitation Program. Arch Phys Med Rehabil [Internet]. 2018 [cited 2020 Dec 14];99(11):2373-7. Available from: doi:10.1016/j.apmr.2018.06.027.
  39. Mendell J, Bates J, Banner-Lukaris D, Horvat D, Kang B, Singer J, Ignaszewski A, & Lear SA. What Do Patients Talk About? A Qualitative Analysis of Online Chat Sessions with Health Care Specialists During a “Virtual” Cardiac Rehabilitation Program. Telemedicine and e-Health [Internet]. 2019 [cited 2020 Dec 14];25(1):71-8. Available from: doi:10.1089/tmj.2017.0206.
  40. Canadian Cardiovascular Society. Quality Indicators For Cardiac Rehabilitation and Secondary Prevention. [Internet]. Ottawa: The Canadian Cardiovascular Society; 2013. [cited 2021 Apr 19]. Available from: https://ccs.ca/app/uploads/2020/12/Indicator_CR.pdf.
  41. Varnfield M, Karunanithi, MK, Särelä A, Garcia E, Fairfull A, Oldenburg BF, & Walter DL. Uptake of a technology-assisted home-care cardiac rehabilitation program. MJA [Internet]. 2011 [cited 2020 Dec 14];194(4):S15-S9. Available from: doi: 10.5694/j.1326-5377.2011.tb02937.x.
  42. Banner D, Lear S, Kandola D, Singer J, Horvat D, Bates J, & Ignaszewski A. The Experiences of Patients Undertaking a ‘Virtual’ Cardiac Rehabilitation Program. Glbal Telehealth [Internet]. 2015 [cited 2020 Dec 14]: 9-14. Available from: doi: 10.3233/978-1-61499-505-0-9.
  43. Lear SA. The Delivery of Cardiac Rehabilitation Using Communications Technologies: The "Virtual" Cardiac Rehabilitation Program. Can J Cardiol [Internet]. 2018 [cited 2020 Dec 14];34(10 Suppl 2):S278-S83. Available from: doi: 10.1016/j.cjca.2018.07.009.

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