Background:The low participation rate in cardiac rehabilitation programs is the major reason for rehospitalization, morbidity, and mortality. Home-based cardiac rehabilitation by technological means is an essential component of a ''patient-centered'' approach, which is capable of enhancing the participation rate in rehabilitation programs. Introduction: The aim of this research was to examine attitudes, perceptions, and behavioral intentions toward remote digital cardiac rehabilitation (RDCR) with respect to factors such as age, education, smoking, exercise habits, technological illiteracy, and mobile phone behavior. Materials and Methods: This was a cross-sectional study of 200 adult patients discharged from a hospital after an acute coronary syndrome, cardiac surgery, or percutaneous coronary intervention. All patients answered an anonymous Technology Usage Questionnaire, which examined the relationship between their willingness to participate in the RDCR program and various parameters. The surveys were distributed and completed between July 2017 and November 2017 at the Sheba Medical Center in Israel. Results: Overall, 83% of all participants were interested in participating in the RDCR program. Those with heart failure had a greater interest in the program (100%; p < 0.05), whereas patients after coronary bypass surgery had a lesser interest (71.1%; p < 0.05). The level of attitude toward healthy lifestyle was found to be a significant predictor of willingness to participate in RDCR (odds ratio 2.26; p = 0.01). Sociodemographic characteristics, lifestyle, habits, technological knowledge, age, and gender were not found as significant predictors of interest in RDCR. Conclusions: The RDCR program was acceptable to most cardiac patients, including the elderly population, and could be a potential solution for patients who avoid traditional rehabilitation programs in medical centers.
Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Cardiac Prevention and Rehabilitation Institute, Leviev Heart Center, Sheba medical center Introduction Remote cardiac rehabilitation (RCR) is recognized as a viable alternative to conventional, center-based rehabilitation. However, to achieve meaningful functional improvement, a high level of adherence and motivation to collaborate with the healthcare team, is necessary. The feasibility of RCR among patients who actively avoid hospital rehabilitation has not been adequately investigated by randomized studies. Method This year-long prospective study enrolled 60 cardiac patients at various risk levels, including those with heart transplants and heart failure, who refused to participate in conventional rehabilitation. Accordingly, 40 participants were randomized to a 6-month RCR program, while the remaining 20 received usual care in the community. Both groups were monitored for activity and self-reported outcomes. RCR is based on behavioral theories, includes multidisciplinary support, motivational and educational content, regular exercise, controlled by a smart sports watch, and transmitted to both the medical operations center and the patients mobile phone application. The main outcome was the change in Peak VO2, measured by the Cardiopulmonary Exercise Testing, after 4 months of intervention compared to baseline. Results The study included 60 patients, 82% men, aged 55 (±12), who were admitted to the 6-month RCR program mainly after myocardial infarction or coronary interventions (44%), heart failure (29%), cardiomyopathy (13.5%) and heart transplantation (10.5%). After RCR, there was a significant increase in Peak VO2 in the intervention group (+2.46±7.1 mL/(kg·min) compared to the control group (-0.72±7.9 mL/(kg·min) (p<0.001). High-density lipoprotein (HDL) levels also improved significantly. The average minutes per week of aerobic exercise was 221 (±124.74), which was 147% of the goal. The average minutes at the recommended target heart rate was 117.38 (±78.36), and the percentage of intensity of training was 69.39% (±15.11) of the maximum capacity. The average aerobic sessions per week was 5 (±3), while the resistance sessions was 0.8 (±0.74). The average daily step count in the intervention group was 9145 (±3860) versus 4445 (±3005; p<0.001). The surveys showed a significant improvement in patients’ mental and physical perception of health in the intervention vs. control group. Conclusion The adherence and results achieved by patients in RCR who avoided conventional rehabilitation were well within guideline recommendations, resulting in a significant improvement in physical capacity. Risk level, age, and lack of motivation at the beginning of the program were not barriers to achieving goals and cooperation.
Funding Acknowledgements Type of funding sources: None. Introduction The global crisis of COVID-19 has highlighted how the health care system needs to adapt. With the announcement of a partial lockdown, cardiac rehabilitation centers in Israel were closed and patients were left without regular training and risk factor management. However, the Remote Cardiac Rehabilitation Programs (RCRP), which had been previously developed, continued to function. The purpose of this study was to evaluate the performance of RCRP during the pandemic. Methods We compared retrospective cohort data on the performance of RCRP patients and care teams over two time periods: (P1) nine weeks before lockdown; and (P2) seven weeks during the lockdown. Included in the analysis were parameters of exercise adherence, objective training efficacy, and satisfaction. Results The analysis included 38 patients, 92% male, age 58 ± 11 enrolled in the RCRP predominantly following myocardial infarction or coronary interventions (57%). Patient activity during the lockdown period increased with higher average exercise minutes per week as well as higher exercise minutes performed at the designated target heart rate (all P for trend < 0.05). In a mid-study survey, over 86% of patients responded that they felt safe and satisfied with the RCRP. Conclusions The RCRP has proven to be reliable and effective in maintaining the mental and physical health of patients in the face of a national crisis, even with a substantial reduction in staff. Automation by flexible rules, incorporated in the system, resolved numerous time-consuming tasks, thus allowing for more time to be dedicated to human interaction. Assessed parameter Entire study duration Period 1 Period 2 P value Aerobic minutes per week, average 221.1 205.5 241.7 0.01 Number of Aerobic sessions per week, median 3.8 3.6 4 NA Average number of Minutes at Target HR per session, per week (% of session time at target HR) 116.2 (52.5%) 107.7 (52.4%) 127.2 (52.6%) < 0.001 The average %HRR during aerobic session, per week 75.7 75.4 76.1 0.47 Steps per day, average 8,830 9,000 8,600 0.06 Mobile application entries per week, average 4.43 4.3 4.6 0.50 Patients activity before (P1) and during (P2) the lockdown Abstract Figure. The clinical program management center a
Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Sheba Medical Center Introduction Cardiac rehabilitation is an essential program for the reduction of future cardiac events and improve quality of life. However, many vulnerable individuals do not achieve this desired outcome due to the restrictive nature of institution-based rehabilitation. With this in mind was developed the Remote Cardiac Rehabilitation Program (RCRP). Our aim was to create the optimal conditions so that our patients are guided and stimulated in order to successfully complete the program. Material and method This study involved 306 patients with established CHD who underwent a six-month RCRP, three months of which were subsidized by health insurance. RCRP involves regular exercise, monitored by a smart sports watch and transferred to both the medical operations center as well as the mobile application on the patient’s smartphone. We built models to get predictors for the best patient performance in the last (third) month. Predictions were made based on their performance in the first month and some demographical data. Age and gender were taken as base features to all the models. Results and discussion The study involved patients, 81.5% men, aged 57.59 (±10.62), who were admitted to the RCRP mainly after myocardial infarction or coronary interventions (49%). The median minutes per week that patients performed aerobic exercise was 164, a median of 92 minutes at target HR (established by exercise physiologist), and the median percent of heart rate reserve was 76 % across exercise training. The median number aerobic sessions per week was 4, while the median daily steps was 8,370. Values had no significant differences across the 24 weeks. Following the 24-weeks of intervention, there was a significant improvement in exercise capacity, assessed by estimated METS using pre and post exercise stress tests from 9.95±2.57 to 11.71±3.43 (p<0.001). The most significant predictors of program adherence were older age and the number of weekly aerobic minutes and sessions in the first weeks of training (p<0.005). There is a direct relationship between the patient's age and the program compliance - the older the patient, the higher the compliance. Conclusion Adherence and the performance achieved by patients in the RCRP is well within guideline recommendations, leading to a significant improvement in exercise capacity. Older age, as well as early program adherence were significant factors which led to better program completion.
Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Sheba medical center Background Remote cardiac rehabilitation (RCR) after myocardial infarction is an innovative program in the field of telemedicine. RCR is included in the health basket. Many believe that telemedicine programs better fit younger patients, whose technological literacy is higher than older patients. Older patients are also thought to have difficulty consuming technology-based programs and meeting program goals. The objectives of this study were as follows: 1) To study patterns of physical activity, goal achievement, and improvement in functional level among RCR participants over 65 compared with younger patients. 2) To study the variables that can predict better patient adherence and compliance with the rehabilitation program. Methods A retrospective study of post-myocardial infarction patients enrolled in six-month RCR program. The activity of the patients was monitored using a smart watch. The data were collected and analyzed by a special telemedicine system. RCR program goals were: (i)150 minutes of aerobic activity per week; (ii) 120 minutes of the activity within the target heart rate; (iii) 8000 steps per day. Predictive models were created to evaluate variables predicting adherence and compliance with the program. Results 306 participants, 80 of them were elderly (average age 70 ± 3.38). At the end of the program, there was a significant improvement (p <0.001) in the functional capacity of all participants. The elderly improved from 8.11 ± 2.8 to 11.25 ± 12.6 METs, while the final METs results in the elderly group were similar to other participants. During all program months, the elderly showed better achievement of program goals compared to younger ones (p <0.01). We found that age of patients is a clear predictor (p <0.01) of early dropout from the program and goals achievements – the higher the age, the fewer dropouts and better achievement. Conclusions Elderly can successfully participate in telemedicine rehabilitation programs, and such programs are beneficial for them. Age is not a limitation, but a predictor for better achievement of goals and compliance with the RCR program.
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