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According to a study from the Journal of Cardiopulmonary Rehabilitation and Prevention, virtual and hybrid cardiac rehab can provide similar benefits like in-person treatment programs for patients with chronic lung and heart conditions.

When the COVID-19 pandemic hit the globe, it managed to impair options for in-person programs for patients with COPD, which forced many of these cardiac rehab centers to adopt a hybrid or virtual method to deliver care.

What Do Researchers Have to Say?

It’s interesting to note the difference between these delivery channels based on quality and effectiveness. Researchers at UC San Francisco looked at in-person, virtual, and hybrid cardiac rehab from enrolment to completion to compare functional changes in patients. Collected data from the 6-minute walk test and several other tests measuring anxiety, depression, blood pressure, cardiac self-efficacy, and waist-to-hip ratio to compare the three groups.

Researchers found that hybrid and virtual cardiac rehab care methods have similar potential to deliver clinical benefits like in-patient care. Anxiety levels, walking ability, and blood pressure control showed similar promise in virtual and hybrid care settings as in the in-person group.

What makes virtual and hybrid outcomes so promising is that these care options can be implemented to increase availability without deteriorating the quality of care and treatment outcomes.

Cardiac rehabilitation centers must take a close look at the potential benefits of virtual and hybrid programs, including their role in increasing cardiac rehab applications and enhancing overall health, and use the information to provide superior quality of care to patients.

Additional studies have also highlighted the efficacy of virtual and hybrid care methods in improving provider and patient satisfaction. The Mayo Clinic conducted a poll, concluding that hybrid models were popular and extensively used among patients. A hybrid care method was implemented initially to deal with COVID-19 restrictions and increase the availability of virtual care. In fact, patients spending even one night at the Mayo Clinic’s Hybrid Care Hotel relayed high levels of comfort and high satisfaction rates while having their needs adequately met.

According to another 2019 study, hybrid care models offer similar effectiveness after comparing patients’ opinions on in-person and virtual care. Thus, researchers believe that rural patients could significantly benefit from choosing the virtual visitation option as it reduces treatment time while increasing follow-up visits.

Only 24 percent of U.S. patients join cardiac rehabilitation programs because of logistical and financial barriers. Fortunately, a hybrid and virtual care method could solve these issues to a greater extent. Despite that, virtual and hybrid cardiac rehabilitation is often unavailable and underutilized. More cardiac rehabilitation centers need to take the initiative to implement virtual and hybrid CR programs as a practical means of increasing flexibility and CR capacity to meet the specific needs of patients.

Are Virtual Cardiac Care Options More Cost-Effective?

A systematic review examining publications of economic evaluations in cardiac rehab since 2001 found that cardiac rehab is cost-effective as compared to usual care. When incremental cost-effectiveness ratios per (ICERs) per quality-adjusted life year (QALF) were compared between home-based and center-based cardiac rehabilitation, no significant differences were found.

Four studies included in the review highlighted that telerehabilitation was the most cost-effective, offering wide-ranging ICERs, including more effective and less costly compared to usual care.

Because patient commitment to digital solutions is variable, when telerehabilitation gets more widely adopted, it can lead to a significant reduction in costs of cardiac rehabilitation.

Another UK-based study also concluded that home-based cardiac rehabilitation could be more cost-effective in healthcare.

What Could Be the Possible Benefits and Downsides of Virtual Cardiac Rehab?

Here are some of the potential benefits of adopting a virtual cardiac rehabilitation model –

● Expanded access/capacity
● Reduced delays in enrolment
● Personalized programs
● Flexible and convenient scheduling
● Reduced transportation/travel barriers
● Better integration with a home routine
● Greater privacy

However, virtual cardiac rehab has a few downsides compared to center-based programs. Let’s take a close look at a few of them –

● Lack of reimbursements (in some countries)
● Less social support
● Less intensive exercise training
● Less accountability from patients
● Safety concerns. Especially with high-risk patients
● Less face-to-face monitoring
● Lack of published standards specific for home-based cardiac rehab

What Can Cardiac Rehab Centers Do to Enhance Virtual Delivery of Programs?

Every cardiac rehabilitation center transitioning to a more home-based care model must incorporate the following in their remote program delivery –

Tip #1 – Making It Easy

● It’s not easy for the staff to adjust to virtual care, so providing tip sheets could be extremely handy.
● Instead of looking at the myriad of available resources, stick to one online resource that’s verified and comprehensive to guide staff and patients.

Tip #2 – Encouraging Choice in Patients

● Ask patients to take minimum intake assessments to talk about their opinions regarding the merits of home-based cardiac rehab.
● Take on a shared decision-making approach for enrollment that can ensure patients understand the potential benefits of virtual care and the risks of choosing to delay care.

Tip #3 – Focusing on Core Components

● Provide education, psychosocial support, lifestyle risk management, and medical advice.
● Offer simple exercise prescriptions to encourage low-to-moderate physical activity in patients.

Tip #4 – Obtaining Patient Metrics

● Administer appropriate tests and tools to collect data, such as self-administered sex-minute walk test to measure exercise capacity, blood pressure cuffs to measure blood pressure, personal scales for weight, etc.

Tip #5 – Offering Group Sessions

● Reduce one-to-one sessions whenever possible to provide group video conferencing sessions for patient support and education.

Tip #6 – Evaluating Program Efficacy

● Develop an evaluation process to assess the efficacy and merits of virtual cardiac care objectively.

Tip #7 – Investing in Access

● For under-resourced and rural areas, consider providing smartphones, tablets, or other digital options on loan to increase accessibility for participants from those areas.

Conclusion

Because of poor patient participation rates in conventional cardiac rehab programs, there has been a need for digitally delivered and home-based interventions. As the COVID-19 pandemic presented the health community with the opportunity to make the switch, emerging evidence points out that hybrid and virtual cardiac care are excellent alternatives to in-person treatments. More cardiac rehab centers will likely adopt hybrid models in the future, including providing patient choice to enhance the quality of care, treatment efficacy, and program availability.

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