Authors (including presenting author) :
Wong KF(1), Fu TY(2), Fan K(1), Lau KW(1), Ho MP(2), Tsang MF(2), Chan SL(1), Cheng KY(1), Lee MY(1), Ho KL(3), Au WK(3)
Affiliation :
(1) Cardiac Medical Unit, Grantham Hospital
(2) Physiotherapy Department, Grantham Hospital
(3) Cardiothoracic Surgery Department, Queen Mary Hospital
Introduction :
COVID-19 pandemic has significant impact on healthcare globally. In Hong Kong, policies and warnings encourage physical distancing and most hospital-based cardiac rehabilitation (CR) programs were suspended. As cardiac surgeries were performed on urgent clinical needs, the need for cardiac rehabilitation service remained. Adoption of digital technology in CR innovations can facilitate or maximize care quality and effectiveness. We implemented cardiac tele-rehabilitation (CTR) program as a solution for optimal CR delivery during COVID -19.
Objectives :
To assess the outcome of CTR with remotely supervised aerobic exercise training in patients post cardiac surgeries.
Methodology :
Patients who were enrolled in CTR group first attended two supervised center-based exercise sessions. Baseline functional capacity (treadmill exercise and 6 minute-walk tests, 6MWT) and muscle strengths (hand grip strength and quadriceps strength) were measured. Exercise prescriptions with goals and target HR zone with coaching were provided. Monitoring of treatment progression were performed through remote data collection of heart rate, exercise duration and distances collected from wearable devices, online survey reporting rate of perceived exercise intensity and remote coaching through secured messaging, telephone and video consultations. Post-rehabilitation assessments were performed after 12 weeks’ program. Results were compared with match-controlled CR patients undergoing usual care (UC).
Result & Outcome :
From 7/2020 to 10/2021, 36 patients (67% men, mean age 57±9.2 years) were enrolled CTR (n=18) and UC (n=18). 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%). Both groups demonstrated significant improvement in MET scores and 6MWT distance after completion of CR programs. Compared with UC, CTR showed significant increased % change in MET score (22% vs 7%; p=0.02) and 6MWT distance (11% vs 5.3%; p=0.01). Average home exercise time in the CTR group was 379 ±98 minutes/week. Muscle strength in both groups showed an improving trend but no significant difference. No adverse events were reported.
Significant improvement in functional status with excellent adherence can be demonstrated in comprehensive individualized CTR program. Adoption of digital technology with full integration into standard cardiac tele-rehabilitation programs should be recommended beyond COVID-19 period.
