ABSTRACT
Background: Aerobic exercise is a critical component of cardiac rehabilitation (CR) for patients (pts) who have undergone cardiac surgery. Exercise-based CR is ideally home-based and directly supervised by a trained physiotherapist. During COVID-19 pandemic in Hong Kong, there was increasing emphasis on social distancing and caregiving strategies to better reach pts outside hospital. As most cardiac surgeries were performed on urgent clinical needs including heart transplantation and aortic dissection, we implemented hybrid telerehabilitation (HTR) with transition to the use of remote care in order to continue comprehensive CR. We report the functional outcome of HTR group compared with usual care (UC) group. Methods: From 7/2020 to10/2021, 36 pts ( 67% men, mean age 57±9.2 years) were enrolled into HTR (n=18) and UC (n=18) groups respectively for 12 weeks' duration. Demographics in both groups were similar. Types of cardiac surgeries were heart transplant (n=5;14%), CABG (n=6;17%), valvular surgery (n=17;47%) and aorta operation (n=8;22%). An individualized exercise prescription for HTR at home was determined based on initial standardized assessments in hospital and tailored to fit lifestyle and home environment. For HTR group, the goal is set at 150 minutes of low to moderate-intensity aerobic exercise per week at home. Exercise is progressed weekly based on daily metrics recorded by wearable device (exercise log and % target heart rate reserve (THRR) attained) 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. Functional capacity parameters were evaluated using symptom limited exercise treadmill test (ETT) and 6 minute walk test (6MWT). The advised level is based on the current activity level of the patient using a MET score list at intake by the physiotherapist. Handgrip and quadriceps strength were measured. Results: All pts participated the programs. Both groups demonstrated significant improvement in MET scores and 6MWT after completion of CR programs.(Table ) Average exercise time at home was reported to be 379 ±98 minutes/ week (72% achieved >150 minutes/ week). Compared with UC, HTR showed significantly increased%change in MET score at baseline and upon completion of CR (22.1% vs 7%;p=0.02) and 6MWT (11.1% vs 5.3%;p=0.01). The effect muscle strength were similar in both groups with improving trend but no significant% change at baseline and end of CR. Conclusion: Significant improvement in functional status can be demonstrated in comprehensive individualized HTR program in pts after major cardiac surgery. Adoption of digital technology with full integration into standard cardiac rehabilitation program should be recommended. (Table Presented).
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.