By Anna Horner | News & Views
A major hurdle in cardiac rehabilitation is getting people to show up – overall, less than 30% of eligible patients participate – and that's been a challenge long before the COVID-19 pandemic added even more barriers to access. The take-up rate is low for a number of reasons, including inflexible work schedules, inconvenient program hours, significant distance from the facility, lack of transportation, a sick child and more. Alternate delivery models are increasingly necessary to improve participation rates, and virtual rehab could offer a more convenient option for patients who find it difficult to take part in traditional facility-based CR.
Some health systems may be hesitant to implement a virtual CR program due to concerns about patient safety, access to the necessary equipment and reimbursement, particularly given the approaching end of the COVID-19 public health emergency. However, according to Robert Berry, MS, ACSM-CEP, clinical coordinator of cardiac rehabilitation at Henry Ford Health in Detroit, a virtual CR program can be established with a minimal hardware investment using resources already in place at most health systems. "Virtual cardiac rehab is designed to help overcome barriers to participation that are common in a facility model," he explains.
Berry notes that Henry Ford launched its virtual CR program in 2016 with a hardware investment of about $300. On the patient side, all that's needed is a smart device with a camera, earbuds/headphones and internet access. According to Berry, nearly all patients, even in an economically disadvantaged area like Detroit, have access to this basic equipment. "Patient response and acceptance of the virtual delivery model have been overwhelmingly positive,” says Berry. “We did a pilot study in 2016 into early 2017, and while it wasn't a real big sample size, maybe like 20 people or so, our overall patient satisfaction score was slightly higher in the virtual CR group than in the traditional facility-based group."
In his AACVPR live webinar on March 3, Berry will discuss the benefits of virtual CR, address common concerns related to developing virtual CR programs and provide an update on post-pandemic reimbursement. He emphasizes that the guidelines and outcomes are the same for virtual and facility-based CR. Patients participating in CR programs "stay out of the hospital because they're in better shape. They have fewer heart attacks and fewer heart failure exacerbations," he says. "When you're doing a virtual CR program, if you want to have the same magnitude of benefits, you have to do the same level of training."
Berry points out the numerous benefits of virtual CR programs, for both patients and providers. "It's way more efficient for a provider to be in one location seeing patients who are geographically spread out. I can sit here in Detroit and hold a virtual visit with someone who's 350 miles away in the Upper Peninsula, where the nearest local hospital offering cardiac rehab is a 90-minute drive one way," he says. "Realistically, is somebody going to drive three hours to exercise for an hour, three times a week? That's what this program was designed to overcome. The program was never designed around COVID; it was designed for increasing accessibility."
Virtual CR programs are meant to be flexible; patients use home exercise equipment, walk around their neighborhood or even follow free exercise videos from YouTube. "The mode usually isn’t a limiting factor," Berry asserts, "and the way we control and ensure patients are getting the same level of training is that most participants have had a stress test, from which we've calculated a training target heart rate range for them."
Overall, virtual CR programs are designed "to move the needle on CR participation rates," says Berry. "One of the primary goals for cardiac rehab, whether it's virtual or facility-based, is getting people to understand how to use physical activity for lifelong control and management of their chronic disease. So that means teaching them how to exercise independently and knowing how hard is too hard and how hard is not hard enough. That's a big part of what we do."
The livestream event has ended. Please click here for access to the webinar recording, available at no cost to AACVPR members.