ABSTRACT
Background: We have witnessed a dramatic dip in adherence to cardiovascular health behaviors during the COVID-19 pandemic. Data from across the globe has shown that risk factors for cardiovascular disease (CVD) such as decreased physical activity, poor diet, and increased depression, loneliness, and stress have peaked during the pandemic. Having been badly affected by the pandemic and having had prolonged periods of countrywide lockdown, the at-risk and established CVD population has faced a major challenge in adhering to a healthy lifestyle in India. Purpose(s): This study aimed to analyze the change in cardiovascular health behaviors brought about by a comprehensive lifestyle intervention program (CLIP) during the pandemic in India. Method(s): All at-risk and CVD patients who had participated in the CLIP from mid 2020 to mid 2022 and had completed the internally validated health behavior assessment questionnaire, pre and post-program, were included in this retrospective study. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician, and Counseling Psychologist provided the sessions online and/or in-person for the home-based and hybrid programs respectively. When a combination of online and in-person sessions were provided for a subject, it was called a hybrid program. The core components of the CLIP were exercise training, education on relevant health topics, nutritional guidance and psychosocial counseling. Result(s): Age of the subjects (n=50) at enrolment was 54+/-13 years and 40 (80%) were male. The time between pre-program and post-program assessments was 110 (IQR 47) days. Number of at-risk and CVD patients attending home-based and hybrid programs are shown in the Figure. There were 4 couples in the study cohort;21 (50%) of the remaining 42 subjects had at least 1 other family member attend the majority of sessions. There was a significant improvement in all the cardiovascular health behaviors, namely adequate daily intake of fruits, vegetables and whole grains, choice of heart-healthy foods between meals, sufficient weekly exercise and a reduction in self-reported chronic stress, upon completion of the CLIP (Table). Conclusion(s): A comprehensive lifestyle intervention program that incorporates a multipronged approach to behavior modification is effective in improving cardiovascular health behaviors in individuals at-risk as well as with established cardiovascular disease in India. The ripple effect of behavior modification in the accompanying family members needs to be studied systematically.
ABSTRACT
Objectives: Cardiovascular disease (CVD) is the leading noncommunicable cause of mortality and morbidity globally. In-person education and awareness programs conducted as part of the CVD prevention efforts have either come to a standstill or have been replaced by web-based programs in the COVID-19 era. This study describes the design and execution of web-based programs to improve awareness and educate cardiac patients during the pandemic. Methods: All web-based education/awareness sessions conducted since the start of the government-enforced lockdown in India till date (23 March-10 September 2020) were included. A multidisciplinary team consisting of Physician, Physiotherapist and Dietician worked completely online to maintain continuity of service to previously enrolled patients and to develop comprehensive web-based programs for newly enrolling patients. Patient education sessions were incorporated into the homebased CVD prevention/rehabilitation programs, which also consisted of supervised exercise sessions. Web-based awareness programs about CVD prevention strategies during the pandemic were provided to corporate employees, paying special attention to the psychosocial challenges of working from home, and to the general public. Google Meet or Zoom was used for the audiovisual presentation followed by discussion. Results: Our team provided 28 web-based education sessions and 6 awareness webinars for a total of 185 individuals during this period. The topics covered are provided in the Table. The enrolees and their family members actively participated in the sessions and interacted during the discussion. The feedback was that the communication was clear and that the online sessions were effective. The only barrier was the occasional technical snag or connectivity issue, which hindered the continuity of the session briefly. Conclusion: There has been a huge sea change in the way healthcare has been delivered during the COVID-19 pandemic and CVD prevention services are no exception. Web-based programs with online sessions replacing inperson sessions are proving to be effective in patient education and awareness creation and might be the way forward even after the pandemic in resourcelimited settings like India.
ABSTRACT
Objectives: Home-based cardiac rehabilitation (HBCR) and prevention programs (HBPP) which occupied a small proportion of the overall Preventive Cardiology work in the past have become mainstream during the COVID-19 pandemic. This study aims to analyse the design and delivery of HBCR/HBPP pre and during the pandemic to address evolving patient needs. Methods: All patients who had undergone HBCR/HBPP at our Preventive Cardiology centre in Chennai, India till 22 March 2020 (pre-pandemic enrolees) and from 23 March-10 September 2020 (during-pandemic enrolees) were included. Hybrid programs had some in-person and some online/phone sessions;completely home-based programs had only online/phone sessions. Intake evaluation consisted of physician consultation, review of medical records, health-related lifestyle questionnaire, quality of life questionnaire, 24-hour diet recall and body mass index and functional capacity (FC) assessment. The sixminute walk test (6MWT) or the 2-minute step test (2MST) was used for FC assessment. A multidisciplinary team consisting of Physician, Physiotherapist and Dietician provided 1-2 sessions per week for 3-6 months. HBCR was offered to low/medium risk patients. Results: Of the 29 subjects (57±13 years, 69% male), 16 (55%) were prepandemic enrolees and 13 (45%) during-pandemic enrolees. Completely homebased programs were provided to 4 (25%) of the pre-pandemic enrolees and to 13 (100%) of the during-pandemic enrolees (p=0.0002). Almost all pre-pandemic enrolees resided outside Chennai and travelled by air/train/road for in-person sessions in the hybrid program;an elderly woman residing in Chennai preferred the hybrid program, as she needed a caregiver to accompany her. Majority of pre-pandemic home-based sessions were phone calls whereas majority of during-pandemic sessions were online video sessions with supervised exercise and/or audiovisual presentation. FC was assessed using 6MWT in 17 (59%) and 2MST in 9 (31%) subjects;FC was not assessed in 3 pre-pandemic enrolees. No adverse events were reported. Conclusion: Multidisciplinary HBCR/HBPP is an effective and safer alternative to traditional programs. There is potential to expand these services post-pandemic to all patients irrespective of place of residence and risk profile.
ABSTRACT
Background: Home-based cardiovascular disease (CVD) primary prevention (HBPP) and cardiac rehabilitation (HBCR) programs which occupied a small proportion of the overall Preventive Cardiology work in the past have become mainstream during the COVID-19 pandemic. Purpose: This study aims to analyse the effectiveness of a home-based CVD prevention program implemented during the pandemic in India. Methods: A retrospective study was conducted on pre-pandemic and pandemic enrolees. Health behaviour, CVD risk factors, physical and mental component score (PCS, MCS) from SF-12 questionnaire, body mass index (BMI), 6-minute walk distance (6MWD), and clinical and biochemical parameters were assessed. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician and Counselling Psychologist provided the program using tele-health platforms. Results: Of the 66 subjects (55 ± 13 years, 73% male), 17 (26%) enrolled pre-pandemic and 49 (74%) enrolled during-pandemic, 28 (42%) were HBPP and 38 (58%) were HBCR participants. Majority of the subjects (n = 51, 77%), with significantly more HBCR than HBPP participants, harboured 4 or more risk factors (p = 0.04). In the 60 (91%) program completers, BMI, 6MWD, PCS and MCS had improved significantly. SBP, DBP, LVEF, HbA1c, total cholesterol and LDL had improved significantly in affected subjects. Completely home-based participants (n = 44, 67%) who never had any in-person contact with the team during the program also showed significant improvement. No adverse events were reported. Conclusion: Comprehensive home-based CVD prevention programs are effective in improving anthropometric, clinical, biochemical and psychosocial parameters, are a safe alternative to conventional programs and could potentially become the standard-of-care in the post-pandemic era. (Figure Presented).