Abstract 16159: Randomized Trial of a ‘Virtual’ Cardiac Rehabilitation Program Delivered at a Distance via the Internet
Background: Cardiac rehabilitation programs (CRP) are essential for secondary prevention, yet only 10% - 30% of eligible patients attend. One of the main barriers to attendance is physical proximity as many CRP are limited to hospitals in large urban areas. We evaluated a ‘virtual’ CRP (vCRP) to provide access to patients outside of these areas.
Methods: Patients (n=78) living in small urban and rural areas were recruited at hospital admission for either acute coronary syndrome or revascularization procedure and randomized to usual care (UC) or the vCRP. The vCRP was a four-month program through the Internet to mimic standard hospital-based CRP. The vCRP included the use of a recordable heart rate monitor that connected with the vCRP website; data capture for exercise stress test and blood test results; education sessions; progress notes; monthly ask-an-expert group chat sessions; and private online chat sessions with a nurse, exercise specialist and dietitian. Both groups were assessed at baseline, four months and 16 months for study outcomes. Participants in the vCRP underwent exit interviews. The primary outcome was change in maximal time on the treadmill (MTT) stress test (i.e. exercise capacity) between the groups using linear mixed effects model adjusted for baseline age, sex, prevalence of diabetes and Internet use for health information.
Results: Data on the primary outcome were available on 69 participants. The mean change in MTT over the initial four months was 48.8 seconds (SE: 22.6) in the vCRP group and 3.0 seconds (SE: 21.4) in the UC group. Over the two follow-ups at four and 16 months, the vCRP group had a higher mean MTT by 45.8 seconds (SE: 22.4) compared to UC adjusted for covariates (p=0.045). There were no differences in lipids, blood pressure and physical activity between the two groups. In interviews, participants in the vCRP were unanimous in their satisfaction with the program.
Conclusion: An Internet-based CRP was effective at improving exercise capacity comparable to hospital-based CRP and this improvement was sustained for a year afterward compared to usual care. These results indicate that the Internet can close the gap in care in secondary prevention by delivering safe and effective care to patients in their homes and communities.
- Cardiac rehabilitation
- Ischemic heart disease
- Health services research
- Healthcare delivery systems
- © 2013 by American Heart Association, Inc.