Virtual Cardiac Rehabilitation Program
Delivering cardiac rehabilitation programming via the Internet
The Virtual Cardiac Rehabilitation Program (vCRP) uses an online interface to mimic the existing outpatient cardiac rehabilitation programs currently in use at hospitals across BC. As a result of the success of the vCRP trial, British Columbia’s Fraser Health Authority is collaborating with our research team to implement the program alongside existing hospital-based cardiac rehabilitation programs (CRPs) in the region (see below).
The original vCRP study tracked a group of ischemic heart disease patients who used the vCRP website over a four-month period in place of a face-to-face cardiac rehabilitation program. Upon completion, patients saw improvement in their exercise capacity, the number of hospital visits, diet and cholesterol levels, and these changes were still present a year later. The vCRP was also cost-effective, using less staff hours than an in-person program.
Existing CRPs are cost-effective and can result in a 25% reduction in mortality. However, despite the known benefits, as few as 10% to 25% of eligible patients attend these programs. One of the main barriers to attendance is proximity to a CRP, as the majority of these programs are limited to hospitals in large urban areas. Unfortunately, cardiovascular diseases do not discriminate by geography; the result is geographic inequity of care for patients living in rural, remote and smaller urban/suburban centres. We believe that the use of the Internet may present itself as a viable alternative to attendance at a face-to-face cardiac rehabilitation program.
vCRP Trial Program
To see whether patients with ischemic heart disease will see significant improvements in exercise capacity after completing a 4-month Internet-based cardiac rehabilitation program and at one-year follow-up, compared to usual care.
Seventy-nine patients with ischemic heart disease were recruited and randomized to usual care or the four-month online cardiac rehabilitation program. Patients in usual care received simple guidelines for safe exercise and healthy eating habits.
Patients in the intervention group received a heart rate monitor, blood pressure monitor and access to the vCRP website. They monitored heart rate during their exercise sessions and uploaded this data to the website for weekly review sessions with their assigned care provider. The vCRP program also allowed patients to track blood pressure and glucose levels and offered one-on-one chat sessions with a cardiac-trained nurse, dietitian and exercise specialist, as well as peer-support group chat sessions. Upon completion of the four-month program, patients were discharged into the care of their primary care physician.
All participants were assessed at baseline, four and 16 months for risk factors and lifestyle behaviours. Exercise capacity was measured at each assessment as total time on a symptom-limited exercise stress test.
- • After 16 weeks in the vCRP, patients saw improvement in their exercise capacity, diet and cholesterol levels, and all of these changes were still present one year after the end of the program.
- • There were fewer hospital visits among patients in the program than in usual care.
- • Drop-out rates were lower (less than 10%) than what is reported in literature (up to 35%).
- • Staff time required to administer the program was lower than in-person care, at 8 hours ($435) per participant.
- • Follow-up interviews revealed that participants found the vCRP to be accessible, convenient and effective. Participants additionally identified that:
- • they came out with greater awareness of and motivation for managing their health conditions and improving
- their lifestyle
- • the program was useful in allowing them to assess and monitor their progress
- • they saw an improvement in health measurements over time
- • they had increased confidence when interacting with healthcare professionals
- • of those who experienced difficulty using the program, the main barrier was computer literacy.
Fraser Health Authority Implementation Project
Members from the Fraser Health Authority (FHA) Cardiac Services Program are partnering with the BCATPR to implement and test the vCRP across the FHA region. The authority is hoping to increase the capacity and reach of cardiac services across both urban and rural areas, and to address the current gap in care.
We aim for 140 cardiovascular disease (CVD) patients to be referred to the vCRP during the project, from either existing FHA CRPs or community physicians.
We anticipate the vCRP will
- a) improve access to cardiac rehabilitation services in urban and rural areas
- b) identify lessons learned and challenges (i.e., what worked and what did not) in the implementation of the vCRP
- c) reduce the CVD risk and improve self-management of patients participating in the vCRP.
The findings will be used to inform the ongoing provision of the vCRP in the FHA and have the potential to be used as a blueprint for use of the vCRP in other health regions.
Heart care at the click of a button: the Internet as an effective mode of delivering cardiac rehabilitation programming
vCRP briefing note, August 2015
Improving Access to Cardiac Rehabilitation Using the Internet: A Randomized Trial
Scott A. Lear, Joel Singer, Davina Banner-Lukaris, Dan Horvat, Julie E. Park, Joanna Bates, Andrew Ignaszewski
Global Telehealth: Integrating Technology and Information for Better Healthcare, 2015
Randomized Trial of a Virtual Cardiac Rehabilitation Program Delivered at a Distance via the Internet
Scott A. Lear, Joel Singer, Davina Banner-Lukaris, Dan Horvat, Julie E. Park, Joanna Bates & Andrew Ignaszewski
Circulation: Cardiovascular Quality and Outcomes, 2014
The use of the Internet to deliver cardiac rehabilitation remotely to patients with cardiovascular disease: Report of the ‘virtual’ cardiac rehabilitation program
Scott A. Lear & Davina Banner-Lukaris
Canada Health Infoway, October 2014
Utilization of the Internet to Deliver Cardiac Rehabilitation at a Distance: A Pilot Study
Amber Zutz, Andrew Ignaszewski, Joanna Bates, and Scott A. Lear
Telemedicine and e-Health, 2007