ABSTRACT
Objectives: Home-based Cardiac rehabilitation (HBCR) models have been implemented as a potential solution to address access barriers to cardiac rehabilitation (CR). During COVID-19 pandemic peak period in Hong Kong, there is increasing emphasis on social distancing and caregiving strategies to better reach patients (pt) outside hospital. We designed and implemented HBCR amongst cardiac pts recovering from major cardiac surgeries including heart transplantation. We report our early 4 weeks' experience of HBCR during peak COVID-19 outbreak and explore the safety and feasibility of HBCR with telecommunication and tele-monitoring using wearable device (WD). Methods: Twelve pts (8 men (66%);mean age 52.6±9.7) were enrolled in July 2020. There are 5 post-heart transplant pts, 6 post-cardiac surgery pts and 1 post-PCI pt. HBCR includes exercise prescription, nutrition and risk factor modification for 12 weeks. An individualized exercise prescription is determined based on initial standardized assessments in hospital and tailored to fit lifestyle and home environment. Goal is set at 150 minutes of low to moderate-intensity aerobic exercise per week. Exercise is progressed weekly based on daily metrics recorded by WD (exercise log and % target heart rate reserve (THRR) attained), exercise routine and rate of perceived exertion (RPE). These were reported by pts through an online survey after each exercise session which were reviewed daily, with progress follow-up by phone calls or text messages on a weekly basis. Results: All pts participated and uploaded their WD data successfully despite early connectivity issue in 1 pt. 75% pts submitted online survey after each exercise session. Weekly average exercise time was 330 minutes (median). Mean % THRR was 58%. Overall mean reported BP was 118±10 mmHg and mean RPE was 11±1.7. No adverse event or emergency hospitalization reported. Weekly follow-up communications were all successful. One pt with new onset atrial fibrillation was detected with prompt in-hospital consultation. Conclusion: HBCR protocol designed and supervised remotely by dedicated CR team is safe and effective. It is foreseeable that HBCR will continue beyond COVID-19 to serve critical needs of pts with improved utilization of CR.