ABSTRACT
AIMS: Enforced suspension and reduction of in-person cardiac rehabilitation (CR) services during the coronavirus disease-19 (COVID-19) pandemic restrictions required rapid implementation of remote delivery methods, thus enabling a cohort comparison of in-person vs. remote-delivered CR participants. This study aimed to examine the health-related quality of life (HRQL) outcomes and patient experiences comparing these delivery modes. METHODS AND RESULTS: Participants across four metropolitan CR sites receiving in-person (December 2019 to March 2020) or remote-delivered (April to October 2020) programmes were assessed for HRQL (Short Form-12) at CR entry and completion. A General Linear Model was used to adjust for baseline group differences and qualitative interviews to explore patient experiences. Participants (n = 194) had a mean age of 65.94 (SD 10.45) years, 80.9% males. Diagnoses included elective percutaneous coronary intervention (40.2%), myocardial infarction (33.5%), and coronary artery bypass grafting (26.3%). Remote-delivered CR wait times were shorter than in-person [median 14 (interquartile range, IQR 10-21) vs. 25 (IQR 16-38) days, P < 0.001], but participation by ethnic minorities was lower (13.6% vs. 35.2%, P < 0.001). Remote-delivered CR participants had equivalent benefits to in-person in all HRQL domains but more improvements than in-person in Mental Health, both domain [mean difference (MD) 3.56, 95% confidence interval (CI) 1.28, 5.82] and composite (MD 2.37, 95% CI 0.15, 4.58). From qualitative interviews (n = 16), patients valued in-person CR for direct exercise supervision and group interactions, and remote-delivered for convenience and flexibility (negotiable contact times). CONCLUSION: Remote-delivered CR implemented during COVID-19 had equivalent, sometimes better, HRQL outcomes than in-person, and shorter wait times. Participation by minority groups in remote-delivered modes are lower. Further research is needed to evaluate other patient outcomes.
Subject(s)
COVID-19 , Cardiac Rehabilitation , Aged , Cardiac Rehabilitation/methods , Female , Humans , Male , Patient Outcome Assessment , Prospective Studies , Quality of LifeABSTRACT
AIMS: To determine the prevalence and seasonal variation in precipitants of heart failure (HF) hospitalization and the risk of subsequent HF hospitalizations. METHODS: We analysed the characteristics and outcomes of patients hospitalized with HF and enrolled in the Management of Cardiac Failure program in Sydney, Australia. Potential precipitants of HF hospitalization were identified, and Cox-regression analyses performed according to the precipitant. RESULTS: Among 6918 patients hospitalized with HF, 5384 (78%) had identified one or more precipitating factors leading to the hospitalization and 3648 (53%) had a single identifiable precipitant. Most precipitants were due to one or more of five prespecified causes - infection (n = 2014), ischemia (n = 1781), arrhythmia (n = 1724), medication related (n = 925) and diet non-compliance (n = 408). All precipitants were more common during winter (p < 0.001), especially infection related precipitants, of which 36% occurred during winter. Among patients with a single identifiable precipitant, one-year risk for HF readmission was lower when the precipitant was arrhythmia (16%) or infection (17%) than when the precipitant was ischemia (21%), dietary non-compliance (23%) or medication related (25%). The precipitant for HF rehospitalizations were more likely to be the same precipitant for the initial admission: infection vs no infection (HR 1.51, 95% CI 1.08-2.13), ischemia vs no ischemia (HR 2.79, 95% CI 1.83-4.25), arrhythmia vs no arrhythmia (HR 3.31, 95% CI 1.87-5.88) and medication related vs not medication related (HR 2.28, 95% CI 1.39-3.74). CONCLUSION: The precipitant of HF hospitalization influences the risk and precipitant of subsequent HF hospitalizations. Identifying and targeting interventions towards the precipitating factor may be an important strategy to prevent future HF hospitalizations.
