Canadian Journal of Cardiology

COVID-19: A Time for Alternate Models in Cardiac Rehabilitation to Take Centre Stage

Published:April 25, 2020DOI:https://doi.org/10.1016/j.cjca.2020.04.023
      The coronavirus disease 2019 (COVID-19) pandemic has resulted in large-scale social distancing, working from home, prohibiting large group gatherings,

      Hartley DM, Reisinger HS, Perencevich EN. When infection prevention enters the temple: intergenerational social distancing and COVID-19 [e-pub ahead of print]. Infect Control Hosp Epidemiol https://doi.org/10.1017/ice.2020.100. Accessed April 1, 2020.

      and staying at home.
      • Schwiegershausen E.
      Shelter-in-Place and Stay-at-Home Orders: What They Mean.
      These public health measures have been shown to be effective in the influenza pandemic of 1918
      • Hatchett R.J.
      • Mecher C.E.
      • Lipsitch M.
      Public health interventions and epidemic intensity during the 1918 influenza pandemic.
      and continue to hold a place in today’s scenario. Social distancing requires one to maintain a distance of at least 2 m or 6 feet between individuals in public spaces
      World Health Organization
      Coronavirus Disease (COVID-19) Advice for the Public.
      whereas stay at home orders require an individual to remain confined to one’s home with the provision to leave for essential errands (ie, groceries, medicine, and health care).
      • Schwiegershausen E.
      Shelter-in-Place and Stay-at-Home Orders: What They Mean.
      Although these measures are necessary to curb the widespread transmission of respiratory infection disease, their implementation makes the delivery of traditional, centre-based cardiac rehabilitation (CBCR; ie, face-to-face, 12 weeks, 36 sessions) virtually impossible, because CBCR services have been suspended because of their nonessential designation during the COVID-19 pandemic. Essentially, because of the COVID-19 pandemic, the participation rate has decreased to virtually 0%. Before the COVID-19 outbreak, CBCR participation in many jurisdictions, including Canada and the United States was already a long-standing concern, with less than a quarter of eligible American patients participating in traditional cardiac rehabilitation (CR).
      • Ritchey M.D.
      • Maresh S.
      • McNeely J.
      • et al.
      Tracking cardiac rehabilitation participation and completion among medicare beneficiaries to inform the efforts of a national initiative.
      Although many factors are associated with these sobering participation rates, limited access to CBCR is a prominent contributor within the United States and other countries.
      • Ades P.A.
      • Keteyian S.J.
      • Wright J.S.
      • et al.
      Increasing cardiac rehabilitation participation from 20% to 70%: a road map from the Million Hearts Cardiac Rehabilitation Collaborative.
      To increase participation, key CR stakeholders (eg, physicians, allied health professionals, scientists, professional organizations, etc) have been calling for alternate delivery models to increase access and participation. These trends and limitations in accepted alternate delivery models are issues around the world.
      • Babu A.S.
      • Lopez-Jimenez F.
      • Thomas R.J.
      • et al.
      Advocacy for outpatient cardiac rehabilitation globally.
      For example, a global survey showed that the most frequent methods of reimbursement for CR included: government coverage, paying out of pocket, private insurance companies, and shared methods (ie, between patient and another source), with a portion of the respondents indicating coverage for abbreviated CR services.
      • Babu A.S.
      • Lopez-Jimenez F.
      • Thomas R.J.
      • et al.
      Advocacy for outpatient cardiac rehabilitation globally.
      Considering the unprecedented closure of CBCR programs because of the COVID-19 pandemic, the need for covered alternative CR delivery models has never been more important.
      • Thomas R.J.
      • Beatty A.L.
      • Beckie T.M.
      • et al.
      Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology.
      ,
      • Clark R.A.
      • Conway A.
      • Poulsen V.
      • et al.
      Alternative models of cardiac rehabilitation: a systematic review.

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