Virtual, hybrid cardiac rehabilitation programs yield benefits similar to in-person
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Patients referred for cardiac rehabilitation sessions experienced similar improvements in clinical outcomes whether the program was in-person, hybrid or virtual, including similar changes in 6-minute walk distance, researchers reported.
The COVID-19 pandemic offered researchers a chance to conduct a first-time comparison of real-world outcomes between the three cardiac rehabilitation delivery modes at a time when cardiac rehabilitation remains widely underutilized, Alexis L. Beatty, MD, MAS, cardiologist and associate professor of epidemiology and biostatistics at the University of California, San Francisco (UCSF), and colleagues wrote in the Journal of Cardiopulmonary Rehabilitation and Prevention.
‘A lot of barriers’
“Research shows that cardiac rehabilitation is a beneficial program, keeps people out of the hospital and helps them live longer, but there are a lot of barriers keeping people from attending,” Beatty told Healio. “Then the pandemic hit, and cardiac rehabs across the country closed or severely limited their services, especially early on, for public health and safety reasons. Many recognized that this was a time of vulnerability for our patients and something needed to be done. Since there was already evidence that virtual programs could be similarly efficacious, many tried it. We were one of the programs that started early.”
Beatty and colleagues analyzed data from 187 patients enrolled in cardiac rehabilitation at UCSF from October 2019 to May 2021, categorized as in-person (38.1%) or hybrid/virtual (64.4%). All patients received individualized exercise training and behavior counseling. Researchers assessed 6-minute walk test times, BP, depression, anxiety, waist-to-hip ratio and cardiac self-efficacy, all measured at enrollment and completion of rehabilitation. The most common reasons for referral to cardiac rehabilitation were MI and PCI, followed by CABG and HF.
Researchers found that improvements in 6-minute walk test scores were similar for patients in virtual (mean, 63.2 m; P = .55) and hybrid groups (mean, 63.4 m; P = .46) compared with patients participating in-person (mean, 51.5 m). The hybrid and virtual patients also experienced similar improvements in BP and anxiety; however, the virtual patients had less improvement in their depression symptoms, according to the researchers.
Researchers did not observe any between-group changes in waist-to-hip ratio or cardiac self-efficacy.
“For patients who cannot come to the center, whether because of COVID-19 or any other barriers, these data show it is possible to achieve similar outcomes with virtual or hybrid cardiac rehab programs,” Beatty said in an interview. “We can overcome barriers by offering programs that allow people to exercise within their home or community and then still have that connection with the cardiac rehab center through weekly virtual visits.”
Personal connection
In interviews with cardiac rehab patients, Beatty said one theme consistently emerged — patients value personal connection, regardless of delivery method.
“Cardiac rehab is one of those things where the connection between the patient and the cardiac rehab staff can be a powerful motivator to make and sustain changes over time,” Beatty said.
UCSF plans to continue virtual and hybrid sessions, Beatty said, adding that reimbursement for virtual or hybrid cardiac rehabilitation remains a concern coming out of the pandemic.
“Part of it is our patients like those formats, and our cardiac rehab center is overcapacity,” Beatty said. “We have a waitlist, and there is no way we could possibly get everyone who needs rehab through our center unless we use some of these virtual or hybrid approaches. That is true for most of the country. There are not enough cardiac rehab centers to serve all the people who need it. These options help address both of those issues.”
For more information:
Alexis L. Beatty, MD, MAS, can be reached at alexis.beatty@ucsf.edu.
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