Clinical Outcomes and Qualitative Perceptions of In-person, Hybrid, and Virtual Cardiac Rehabilitation.
Journal
Journal of cardiopulmonary rehabilitation and prevention
ISSN: 1932-751X
Titre abrégé: J Cardiopulm Rehabil Prev
Pays: United States
ID NLM: 101291247
Informations de publication
Date de publication:
01 09 2022
01 09 2022
Historique:
pubmed:
15
4
2022
medline:
9
9
2022
entrez:
14
4
2022
Statut:
ppublish
Résumé
Cardiac rehabilitation (CR) is evolving to include both in-person and virtual delivery. Our objective was to compare, in CR patients, the association of in-person, hybrid, and virtual CR with change in performance on the 6-min walk test (6MWT) between enrollment and completion. Patients enrolled in CR between October 22, 2019, and May 10, 2021, were categorized into in-person, hybrid, or virtual groups by number of in-person and virtual visits. All patients received individualized exercise training and health behavior counseling. Cardiac rehabilitation was delivered to patients in the hybrid and virtual cohorts using synchronous video exercise and/or asynchronous telephone visits. Measurements at CR enrollment and completion included the 6MWT, blood pressure (BP), depression, anxiety, waist-to-hip ratio, and cardiac self-efficacy. Of 187 CR patients, 37/97 (38.1%) were in-person patients and 58/90 (64.4%) were hybrid/virtual patients ( P = .001). Compared to in-person (51.5 ± 59.4 m) improvement in the 6MWT was similar in hybrid (63.4 ± 55.6; P = .46) and virtual (63.2 ± 59.6; P = .55) compared with in-person (51.5 ± 59.4). Hybrid and virtual patients experienced similar improvements in BP control and anxiety. Virtual patients experienced less improvement in depression symptoms. There were no statistically significant changes in waist-to-hip ratio or cardiac self-efficacy. Qualitative themes included the adaptability of virtual CR, importance of relationships between patients and CR staff, and need for training and organizational adjustments to adopt virtual CR. Hybrid and virtual CR were associated with similar improvements in functional capacity to in-person. Virtual and hybrid CR have the potential to expand availability without compromising outcomes.
Identifiants
pubmed: 35420563
doi: 10.1097/HCR.0000000000000688
pii: 01273116-202209000-00007
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
338-346Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Anderson L, Oldridge N, Thompson DR, et al. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J Am Coll Cardiol. 2016;67(1):1–12.
Centers for Disease Control and Prevention. Million Hearts Cardiac Rehabilitation Change Package. https://millionhearts.hhs.gov/tools-protocols/action-guides/cardiac-change-package/index.html . Published June 22, 2020. Accessed March 4, 2021.
Heran BS, Chen JM, Ebrahim S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011;(7):CD001800. doi:10.1002/14651858.CD001800.pub2.
Leon AS, Franklin BA, Costa F, et al. Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2005;111(3):369–376.
Long L, Mordi IR, Bridges C, et al. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev. 2019;1(1):CD003331. doi:10.1002/14651858.CD003331.pub5.
O'Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301(14):1439–1450.
Rejeski WJ, Foy CG, Brawley LR, et al. Older adults in cardiac rehabilitation: a new strategy for enhancing physical function. Med Sci Sports Exerc. 2002;34(11):1705–1713.
Shields GE, Wells A, Doherty P, Heagerty A, Buck D, Davies LM. Cost-effectiveness of cardiac rehabilitation: a systematic review. Heart Br Card Soc. 2018;104(17):1403–1410.
Thomas RJ, Beatty AL, Beckie TM, et al. Home-based cardiac rehabilitation. a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. J Cardiopulm Rehabil Prev. 2019;39(4):208–225.
Wall HK, Stolp H, Wright JS, et al. The Million Hearts initiative: catalyzing utilization of cardiac rehabilitation and accelerating implementation of new care models. J Cardiopulm Rehabil Prev. 2020;40(5):290–293.
Ades PA, Keteyian SJ, Wright JS, et al. Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the Million Hearts Cardiac Rehabilitation Collaborative. Mayo Clin Proc. 2017;92(2):234–242.
Park LG, Schopfer DW, Zhang N, Shen H, Whooley MA. Participation in cardiac rehabilitation among patients with heart failure. J Card Fail. 2017;23(5):427–431.
Ritchey MD, Maresh S, McNeely J, et al. Tracking cardiac rehabilitation participation and completion among Medicare beneficiaries to inform the efforts of a national initiative. Circ Cardiovasc Qual Outcomes. 2020;13(1):e005902. doi:10.1161/circoutcomes.119.005902.
Turk-Adawi K, Supervia M, Lopez-Jimenez F, et al. Cardiac rehabilitation availability and density around the globe. EClinicalMedicine. 2019;13:31–45.
Arena R, Williams M, Forman DE, et al. Increasing referral and participation rates to outpatient cardiac rehabilitation: the valuable role of healthcare professionals in the inpatient and home health settings: a science advisory from the American Heart Association. Circulation. 2012;125(10):1321–1329.
Beatty AL, Bradley SM, Maynard C, McCabe JM. Referral to cardiac rehabilitation after percutaneous coronary intervention, coronary artery bypass surgery, and valve surgery. Circ Cardiovasc Qual Outcomes. 2017;10(6):e003364.
Beatty AL, Truong M, Schopfer DW, Shen H, Bachmann JM, Whooley MA. Geographic variation in cardiac rehabilitation participation in Medicare and Veterans Affairs populations: an opportunity for improvement? Circulation. 2018;137(18):1899–1908.
Hinde S, Bojke L, Harrison A, Doherty P. Improving cardiac rehabilitation uptake: potential health gains by socioeconomic status. Eur J Prev Cardiol. 2019;26(17):1816–1823.
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. 2013;33(5):297–302.
Pack QR, Squires RW, Lopez-Jimenez F, et al. The current and potential capacity for cardiac rehabilitation utilization in the United States. J Cardiopulm Rehabil Prev. 2014;34(5):318–326.
Ambrosetti M, Abreu A, Corrà U, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2021;28(5):460–495.
Anderson L, Sharp GA, Norton RJ, et al. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev. 2017;6(6):CD007130. doi:10.1002/14651858.CD007130.pub4.
Beatty AL, Brown TM, Corbett M, et al. Million Hearts cardiac rehabilitation think tank: accelerating new care models. Circ Cardiovasc Qual Outcomes. 2021;14(10):e008215. doi:10.1161/circoutcomes.121.008215.
Chindhy S, Taub PR, Lavie CJ, Shen J. Current challenges in cardiac rehabilitation: strategies to overcome social factors and attendance barriers. Expert Rev Cardiovasc Ther. 2020;18(11):777–789.
Lindman BR, Gillam LD, Coylewright M, et al. Effect of a pragmatic home-based mobile health exercise intervention after transcatheter aortic valve replacement: a randomized pilot trial. Eur Heart J Digit Health. 2021;2(1):90–103.
Varnfield M, Karunanithi M, Lee CK, et al. Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial. Heart. 2014;100(22):1770–1779.
Wakefield BJ, Drwal K, Paez M, et al. Creating and disseminating a home-based cardiac rehabilitation program: experience from the Veterans Health Administration. BMC Cardiovasc Disord. 2019;19(1):242.
Keteyian SJ, Ades PA, Beatty AL, et al. A review of the design and implementation of a hybrid cardiac rehabilitation program: an expanding opportunity for optimizing cardiovascular care. J Cardiopulm Rehabil Prev. 2022;42(1):1–9.
Dalal HM, Doherty P, McDonagh ST, Paul K, Taylor RS. Virtual and in-person cardiac rehabilitation. BMJ. 2021;373:n1270.
Imran HM, Baig M, Erqou S, et al. Home-based cardiac rehabilitation alone and hybrid with center-based cardiac rehabilitation in heart failure: a systematic review and meta-analysis. J Am Heart Assoc. 2019;8(16):e012779.
Jin K, Khonsari S, Gallagher R, et al. Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review and meta-analysis. Eur J Cardiovasc Nurs. 2019;18(4):260–271.
Maddison R, Rawstorn JC, Stewart RAH, et al. Effects and costs of real-time cardiac telerehabilitation: randomised controlled non-inferiority trial. Heart Br Card Soc. 2019;105(2):122–129.
Prasada S, Rambarat C, Winchester D, Park K. Implementation and impact of home-based cardiac rehabilitation in a Veterans Affairs Medical Center. Mil Med. 2020;185(5/6):e859–e863.
Rawstorn JC, Gant N, Direito A, Beckmann C, Maddison R. Telehealth exercise-based cardiac rehabilitation: a systematic review and meta-analysis. Heart Br Card Soc. 2016;102(15):1183–1192.
Keteyian SJ, Grimshaw C, Brawner CA, et al. A comparison of exercise intensity in hybrid versus standard phase two cardiac rehabilitation. J Cardiopulm Rehabil Prev. 2021;41(1):19–22.
Drwal KR, Wakefield BJ, Forman DE, Wu WC, Haraldsson B, El Accaoui RN. Home-based cardiac rehabilitation: experience from the Veterans Affairs. J Cardiopulm Rehabil Prev. 2021;41(2):93–99.
O'Doherty AF, Humphreys H, Dawkes S, et al. How has technology been used to deliver cardiac rehabilitation during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR. BMJ Open. 2021;11(4):e046051. doi:10.1136/bmjopen-2020-046051.
American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). Guidelines for Cardiac Rehabilitation Programs 6th Edition Epub With Web Resource. https://us.humankinetics.com/products/guidelines-for-cardiac-rehabilitation-programs-6th-edition-epub-with-web-resource . Accessed October 5, 2021.
Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1428–1446.
The Calculator Site. Waist-to-Hip Ratio Calculator. http://www.thecalculatorsite.com/health/whr-calculator.php . Accessed October 5, 2021.
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613.
Sullivan MD, LaCroix AZ, Russo J, Katon WJ. Self-efficacy and self-reported functional status in coronary heart disease: a six-month prospective study. Psychosom Med. 1998;60(4):473–478.
American Association of Cardiovascular and Pulmonary Rehabilitation. AACVPR Stratification Algorithm for Risk of Event. https://www.aacvpr.org/Portals/0/2014_AACVPR-Risk-Stratification-Algorithm.pdf . Published 2012.
Gale RC, Wu J, Erhardt T, et al. Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the Veterans Health Administration. Implement Sci. 2019;14(1):11.
Ajzen I. From intentions to actions: a theory of planned behavior. In: Kuhl J, Beckmann J, eds. Action Control: From Cognition to Behavior. SSSP Springer Series in Social Psychology. Heidelberg, Germany: Springer; 1985:11–39.
Venkatesh V, Morris MG, Davis GB, Davis FD. User acceptance of information technology: toward a unified view. MIS Q. 2003;27(3):425–478.
Venkatesh V, Thong JYL, Xu X. Consumer acceptance and use of information technology: extending the unified theory of acceptance and use of technology. MIS Q. 2012;36(1):157–178.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi:10.1186/1748-5908-4-50.
Van Iterson EH, Laffin LJ, Crawford M, Mc Mahan D, Cho L, Khot U. Cardiac rehabilitation is essential in the COVID-19 era: delivering uninterrupted heart care based on the Cleveland Clinic experience. J Cardiopulm Rehabil Prev. 2021;41(2):88–92.
Schopfer DW, Whooley MA, Allsup K, et al. Effects of home-based cardiac rehabilitation on time to enrollment and functional status in patients with ischemic heart disease. J Am Heart Assoc. 2020;9(19):e016456. doi:10.1161/JAHA.120.016456.
Thomas RJ, Petersen CE, Olson TP, Beatty AL, Ding R, Supervia M. Asynchronous and synchronous delivery models for home-based cardiac rehabilitation: a scientific review. J Cardiopulm Rehabil Prev. 2021;41(6):407–412.
Desai K, Anbarasan D, Kayambu G, Yeo TJ. Patient perspectives on the utilization of telehealth in cardiac rehabilitation during COVID-19 pandemic. J Cardiopulm Rehabil Prev. 2021;41(6):436–437.
Banner D, Lear S, Kandola D, et al. The experiences of patients undertaking a “virtual” cardiac rehabilitation program. Stud Health Technol Inform. 2015;209:9–14.
Dinesen B, Nielsen G, Andreasen JJ, Spindler H. Integration of rehabilitation activities into everyday life through telerehabilitation: qualitative study of cardiac patients and their partners. J Med Internet Res. 2019;21(4):e13281. doi:10.2196/13281.
Knudsen MV, Laustsen S, Petersen AK, Hjortdal VE, Angel S. Experience of cardiac tele-rehabilitation: analysis of patient narratives. Disabil Rehabil. 2021;43(3):370–377.
Schopfer DW, Nicosia FM, Ottoboni L, Whooley MA. Patient perspectives on declining to participate in home-based cardiac rehabilitation: a mixed methods study. J Cardiopulm Rehabil Prev. 2020;40(5):335–340.
Beatty AL, Magnusson SL, Fortney JC, Sayre GG, Whooley MA. VA FitHeart, a mobile app for cardiac rehabilitation: usability study. JMIR Hum Factors. 2018;5(1):e3. doi:10.2196/humanfactors.8017.
Forman DE, Fix GM, McDannold S, et al. Decisive bearing of organizational dynamics on the application and success of hospital-based cardiac rehabilitation. Mayo Clin Proc. 2016;91(7):975–977.
Eberly LA, Khatana SAM, Nathan AS, et al. Telemedicine outpatient cardiovascular care during the COVID-19 pandemic: bridging or opening the digital divide? Circulation. 2020;142(5):510–512.