Determinants of participation in cardiac telerehabilitation during the first surge of COVID-19.

BACKGROUND: Participation rates in cardiac rehabilitation (CR) are low. In multiple trials, telerehabilitation (TR) has been demonstrated to be effective. Still, real-life evidence is scarce. During the first surge of the COVID-19 pandemic our centre deployed a TR programme. This study aimed to characterise the patient population that had, for the first time, the opportunity to participate in cardiac TR and to analyse if there were determining factors for participation or non-participation in TR. METHODS: All patients enrolled in CR in our centre during the first wave of the COVID-19 pandemic were included in this retrospective cohort study. Data was collected from the hospital electronic records. RESULTS: 369 patients were contacted in the setting of TR. 69 patients could not be reached and were excluded from further analysis. 208 (69%) patients that were contacted agreed to participate in cardiac TR. No significant differences in baseline characteristics were seen between TR participants and TR non-participants. A full model logistic regression did not reveal any significant determinants on participation rate in TR. CONCLUSION: This study demonstrates that the rate of participation in TR was high (69%). Of the analysed characteristics, none was directly correlated with the willingness to participate in TR. Further research is needed to further assess determinants, barriers and facilitators of TR. Also, research is needed on better delineating digital health literacy and on how to reach also those patients that are less motivated and or less digitally literate.

Cardiac Telerehabilitation　- A Solution for Cardiovascular Care in Japan.

Cardiac rehabilitation (CR) is a well-known intervention for the secondary prevention of cardiovascular diseases. However, in Japan, the outpatient CR participation rate is estimated to be very low. Cardiac telerehabilitation (CTR) can be defined as a remote CR program using digital health technology to support it. Evidence regarding the use of CTR has been accumulated, and the COVID-19 pandemic has accelerated the need for CTR. Japan has sufficient potential to benefit from CTR because, nationally, digital literacy is high and the infrastructure for telemedicine is developed. To overcome several barriers, evidence of CTR in Japan, well-educated multidisciplinary CTR teams, a good combination of center-based CR and CTR, and sophisticated systems including social insurance and adequate legislation need to be developed immediately. CTR has the potential to increase the low CR participation rate in Japan. CTR also has many different effects that not only cardiologists, but also paramedics who engage in CTR, have to be aware of.

Patient experiences and willingness-to-pay for cardiac telerehabilitation during the first surge of the COVID-19 pandemic: single-centre experience.

BACKGROUND: The first surge of the ongoing COVID-19 pandemic led to a shutdown of all non-urgent medical services such as cardiac rehabilitation. Therefore, centres had to develop remote and innovative ways to deliver the core components of CR during this shutdown. This increase in usage of remote rehabilitation services provides a chance to assess patients' experiences and willingness-to-pay of remote CR sessions. METHODS: This was a prospective single-centre study. From 17 July 2020, to 19 August 2020, we conducted an anonymous survey about the patient experiences of the cardiac telerehabilitation services provided at Jessa Hospital Hasselt during the COVID-19 pandemic. A link to an electronic questionnaire was sent via email to 155 patients who were invited to participate in the cardiac telerehabilitation sessions during the closure of the rehabilitation centre due to COVID-19. RESULTS: Fifty-five patients (35% of all invited patients) did participate in remote CR and completed the questionnaire. The mean age of the respondents was 65.4 ± 10.5 years, 63% were male and 70% of the participants were retired. A total of 91% possessed a smartphone and all those patients used their smartphone regularly to send text messages. Ninety-four per cent of the participants were satisfied with the provided telerehabilitation sessions and 70% of the participants would be prepared to pay for these sessions like for centre-based CR sessions. Twenty per cent of patients would even prefer the telerehabilitation sessions above centre-based CR sessions. CONCLUSION: Most patients believed that remote CR could be an option after the COVID-19 pandemic when it is combined with centre-based CR sessions. Patients are willing to pay the same amount for a telerehabilitation session as a centre-based CR session. This demonstrates that highly motivated patients are open to shift certain parts of CR from face-to-face interactions to digital interactions.

Fever and an abnormal chest X-ray during the COVID-19 pandemic.

During the COVID-19 pandemic, a 56-year-old man presented at our emergency department with fever and shortness of breath; Diffuse pulmonary nodular vascular spread lesions were found. Detailed history taking showed a four-week history of fever and night sweats. The man had been under treatment for 2 years with Adalimumab, a tumor-necrosis-factor (TNF) inhibitor, for ulcerative colitis. Before start, screening by tuberculin skin test was negative. Cultures en PCR on BAL and urine were positive for mycobacterium tuberculosis also ocular findings were present. The diagnosis of military tuberculosis was made.