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A people-first approach to cardiac rehabilitation

How do you change the paradigm in a rigid system? When the COVID-19 pandemic emerged in 2020, my team and I didn’t have a choice. We had built our hospital’s in-person cardiac rehabilitation program from the ground up, but this was a moment of reckoning. Our program would need to incorporate virtual care.

Completing cardiac rehabilitation can increase a patient’s life expectancy by up to five years, reduce mortality rates by 36 percent, and lower the chance of going back into the hospital – but most patients don’t participate, and of those who do, more than 90 percent don’t finish the three-month program. One of the main reasons for this is limited access to in-person programs. Many people don’t live near cardiac rehabilitation facilities, and wait times for new patients can be longer than 40 days.

The simple fact is that, nationwide, in-person cardiac rehabilitation programs do not have enough capacity to accommodate everyone who needs this care. By offering virtual cardiac rehabilitation — not as an alternative to in-person programs, but as a complement — we can provide patients with the access, flexibility, and space they need in order to participate.

Now, nearly four years later, my colleagues and I have been successfully offering both in-person and virtual cardiac rehabilitation to a wide range of patients. Here’s what I’ve learned:

First, to really be an effective virtual cardiac rehabilitation program, any offering needs to contain the full spectrum of resources that are available for in-person care. This program is about more than exercises. For a program to meet patient needs and drive the best results, it must incorporate all the spokes of the wheel that in-person offerings can provide. That includes a health assessment, exercise guidance, nutrition counseling, and risk-factor modification. The heart is at the center of these programs, but we can’t forget the mind. Requiring a cardiovascular procedure can trigger and increase a patient’s risk of depression and anxiety. A truly effective cardiac rehabilitation experience, whether virtual or in-person, needs to provide patients with support to address those issues.

Next, a sense of community is critical to the cardiac rehabilitation experience. The COVID-19 pandemic created hesitation about attending in-person programs. Now, in the wake of the pandemic’s peak, fear of social isolation is a growing factor to contend with. If done right, virtual programs can create a sense of individuality while also allowing for group settings to foster that sense of community and convenience. For example, I offer a twice-monthly virtual “town hall,” a 45-minute session of questions and answers with my patients, whose identities are protected, to provide them with an opportunity to discuss their concerns, goals, and responsibilities.

Third, virtual cardiac rehabilitation can be a vital solution for Medicare patients — if we let them use it. We see Medicaid programs at the state level continuing to be underfunded. During the public health emergency, Medicare patients were allowed to participate in virtual cardiac rehabilitation for the first time. That authorization ended in May, and as a result, Medicare beneficiaries were cut-off from 95 percent of the virtual rehabilitation options in the country. There’s bipartisan legislation moving through Congress now that would restore that access, and if it becomes law, it would make a significant difference for many of the patients who need it the most.

Finally, it’s important that we empower patients with everything they need to be successful and healthy. Whether it’s keeping on-call staff to help patients navigate the therapy program on their smartphones, or delivering on-demand, pre-recorded offerings that require less internet speed to allow patients to access their programs at an alternative site, we must remember that a patient’s engagement with their health doesn’t occur in a vacuum. Each person is different, and a one-size-fits-all approach that makes assumptions about technological prowess and patient preference won’t drive the results we’re looking for. We also need to educate patients to help them understand their options. After a patient’s hospitalization, we can use their recovery time before discharge to educate them about cardiac rehabilitation and explain what resources are available. That way, when they go in for their follow-up visit, they have the information, awareness, and education they need to ask about programs available to them.

Ultimately, it’s critical that, in the flood of technology available to us, we don’t lose sight of the humanity that drives results. Virtual cardiac rehabilitation can be the golden solution that we’ve been looking for, but we must deploy it in a way that empowers patients and fosters community, all while focusing on increasing access to this effective and critical resource.

Melissa Tracy is a cardiologist.

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