Impacts of the COVID-19 Pandemic on Cardiac Rehabilitation Delivery around the World

Abstract

BackgroundTo investigate impacts of COVID-19 on CR delivery around the globe, including effects on providers and patients.MethodsIn this cross-sectional study, a piloted survey was administered to CR programs globally via REDCap from April-June/2020. The 50 members of the ICCPR and personal contacts facilitated program identification.ResultsOverall, 1062(18.3% program response rate) responses were received from 70/111(63.1% country response rate) countries in the world with existent CR programs. Of these, 367(49.1%) programs reported they had stopped CR delivery, and 203(27.1%) stopped temporarily (mean=8.3±2.8weeks). Alternative models were delivered in 322(39.7%) programs, primarily through low-tech modes (n=226,19.3%). 353(30.2%) respondents were re-deployed, and 276 (37.3%) felt the need to work due to fear of losing their job, despite the perceived risk of contracting COVID-19 (mean=30.0%±27.4/100). 266(22.5%) reported anxiety, 241(20.4%) were concerned about exposing their family, 113(9.7%) reported increased workload to transition to remote delivery, and 105(9.0%) were juggling caregiving responsibilities during business hours. Patients were often contacting staff regarding grocery shopping for heart-healthy foods (n=333,28.4%), how to use technology to interact with the program (n=329,27.9%), having to stop their exercise because they have no place to exercise (n=303,25.7%), and their risk of death from COVID-19 due to pre-existing cardiovascular disease (n=249,21.2%). Respondents perceived staff (n=488,41.3%) and patient (n=453,38.6%) personal protective equipment, as well as COVID-19 screening (n=414,35.2%) and testing (n=411,35.0%) as paramount to in-person service resumption.ConclusionApproximately 4400 programs ceased service delivery. Those that remain open are implementing new technologies to ensure their patients receive CR safely, despite the challenges.Highlights-COVID-19 has impacted cardiac rehabilitation (CR) delivery around the globe.-In this cross-sectional study, a survey was completed by 1062 (18.3%) CR programs from 70 (63.1%) countries.-The pandemic has resulted in cessation of ∼75% of CR programs, with others ceasing initiation of new patients, reducing components delivered, and/or changing of mode delivery with little opportunity for planning and training.-There is also significant psychosocial and economic impact on CR providers.-Alternative CR model (e.g. home-based, virtual) reimbursement advocacy is needed, to ensure safe, accessible secondary prevention delivery.

Cardiac Rehabilitation Based on the Walking Test and Telerehabilitation Improved Cardiorespiratory Fitness in People Diagnosed with Coronary Heart Disease during the COVID-19 Pandemic

“…In the current situation, where the main interest is to maintain public health during the COVID-19 pandemic, there were no clear recommendations on how to proceed in the rehabilitation of people diagnosed with CHD. The use of effective CR strategies based on the gold standard is problematic in current clinical practice, where CR is reduced or limited [ 15 , 25 ]. Innovative social connectivity methods during home-based CR are crucial to keeping participants motivated until the vaccine for SARS-CoV-2 is widely available.…”

A Social-Ecological Perspective of the Perceived Barriers and Facilitators to Virtual Education in Cardiac Rehabilitation

“…To our knowledge, this is the first study to identify barriers and facilitators for patients to participate in virtual CR education sessions during the COVID-19 pandemic. As described elsewhere, 10 several CR programs adapted their services to continue supporting patients while following public health policies and regulations. Our results showed that intrapersonal, interpersonal, institutional, and environmental factors may influence whether a patient participates in virtual CR education sessions.…”

“…9 A global survey regarding the impacts of COVID-19 on CR showed that three-fourths of programs had complete or temporary cessation of services during the pandemic. 10 In addition, COVID-19 affected the structure, delivery format, and components of chronic disease care, with programs developing innovative ways to deliver the core components of CR. [11][12][13][14] Patient education is considered a core component and quality indicator of CR.…”

Building Capacity Through ICCPR Cardiovascular Rehabilitation Foundations Certification (CRFC)

“…Some applicants were struggling with the language and others had issues accessing the CRFC website within China. This is important, given the second greatest unmet need exists there after India,5 and they currently have the greatest CR growth rates globally to our knowledge 20. Initial interest has been strong.…”

“…This is important, given the second greatest unmet need exists there after India, 5 and they currently have the greatest CR growth rates globally to our knowledge. 20 Initial interest has been strong. There is a post-certification evaluation survey embedded, so we will review learner responses and modify the CRFC accordingly in the future.…”