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Canadian Journal of Cardiology

VIRTUAL, ON-SITE AND HYBRID...HOW DO THE NEW MODELS OF CARDIAC REHAB IN NOVA SCOTIA COMPARE TO THE PRE-COVID PROGRAMS?

      BACKGROUND

      In Nova Scotia (NS) the arrival of COVID-19 led to immediate closures of all cardiac rehabilitation (CR) programs and redeployment of staff. Doors opened again two months later with CR teams needing to quickly develop and implement a virtual version of CR. Months following, with the reduction of COVID cases, programs were transitioned back to in-person on-site/hybrid models. Throughout transitions, the goal was to develop safe, effective and sustainable CR models of care with measured outcomes comparative to core elements of traditional on-site CR.

      METHODS AND RESULTS

      The first version of Virtual Cardiac Rehab (VCR 1) was an eight-week program for 99 patients with individual weekly case management calls from the CR team. Two On-Site CR (O-SCR) programs were later implemented;O-SCR1, an 8 week model with 5 patients/class (n=125) and O-SCR 2, a 12 week model with 9 patients per class (n=98). Due to the 2nd wave of COVID in winter 2020, all programming reverted back to virtual care with a new structured VCR2, a 12 week model (n=96) integrating nurses, dietitians and physiotherapists for individual case managed calls, behavior change counselling, Zoom for Healthcare group sessions and rigorous modeling to emulate the physical program as closely as possible, including exercise prescription. In all models; risk factors, medications and medical history were assessed and when possible blood work and exercise stress tests were completed, along with health behaviour change evaluation for activity and eating patterns. There were no adverse events in the virtual groups. 72% of patients completed the VCR1 model with positive changes in eating and activity patterns and effective medical management. 92% of patients completed VCR2 with improved outcome measures including physiologic measures (currently in analysis phase). The O-SCR1 demonstrated 80% attendance, but pandemic restricted stress testing and blood work resulted in most outcome reports as qualitative, based on questionnaires; showing a significant improvement in dietary fat, fibre, sodium and sugar intake patterns, along with 90% of patients reporting improvements in self-management of eating and exercise goals. With O-SCR2, greater stress and lab data availability demonstrates improved exercise tolerance (METS), lipid profiles and food scores. See Results in Table 1.

      CONCLUSION

      Keeping CR doors open virtually and on-site can be challenging during a pandemic but the NS models are feasible with measurable outcomes that are comparable to on-site CR when modeled as such. Further modelling continues with building safe, sustainable and effective programming options.
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