Virtual cardiac rehab program clicks with remote patients

A cardiac rehabilitation program delivered to patients in small urban or rural communities beat standard care for reducing the risk of cardiovascular disease. The initiative required less than eight hours of staff time per patient, potentially making it a cost-effective way to treat remote patients.

The research team, led by Scott A. Lear, PhD, of Simon Fraser University in Burnaby, Canada, had pilot tested a 12-week virtual cardiac rehab program using eight patients to assess its feasibility. In a randomized study published online Sept. 30 in Circulation: Cardiovascular Quality and Outcomes, they evaluated the safety and effectiveness of four months of virtual vs. usual care and 12 months of follow-up in a larger group of patients.

The trial enrolled 78 participants (40 usual care, 38 virtual care) between 2009 and 2011 who lived in remote areas who had been admitted for either acute coronary syndrome or revascularization. All patients returned at four months for follow-up and then 12 months later for evaluation. The virtual care patients returned to usual care after four months.

Patients randomized to virtual care received and were trained to use a heart rate monitor and a home blood pressure monitor. They also had access to an internet program that included online forms, scheduled one-on-one conversations with a care team, weekly education sessions based on interactive slides, data capture for exercise stress and blood test results and a monthly expert group chat session. Usual care patients were overseen by a primary care physician and received guidelines on safe exercising, eating and nutrition and a list of internet-based resources.  

One patient in the virtual care group never logged onto the website. That contributed to a median log-ons per patient of 27 and median values for exercise and blood pressure measures of 22. The average participant used 2.4, 2.6 and 2.7 hours of staff time by a nurse, dietician and exercise specialist, respectively.

Compared with the usual care group, the virtual care group’s total cholesterol, low-density lipoprotein cholesterol and dietary saturated fat were lower; their dietary protein was higher; and their maximal time on a treadmill was higher by 45.7 seconds at 16 months. The virtual care group recorded eight emergency room or major events vs. 22 in the usual care group.

Patients in the virtual care group who completed an exit interview also reported the program provided improved healthcare access and promoted awareness and self-management.

Participation by some patients in the virtual care group was low, Lear et al observed, and if more had been engaged the use of resources would have climbed. Still, they described their program as “cost efficient and readily sustainable. These results are promising and suggest that a low-cost technology such as the Internet can be used safely and effectively to remotely deliver cardiac rehabilitation.”

They added that larger studies needed to be done to prove the program is reproducible and effective in other patient populations and settings.