SPC365

The rise of the digital era in Cardiac Rehabilitation: can it keep up with the presential model?

Session: Posters (Sessão 4 - Écran 3) - Exercício e Reabilitação Cardíaca 1 - Foco nos Programas de Reabilitação
Speaker: Mariana Sousa Paiva

Congress: CPC 2022
Topic: J. Preventive Cardiology
Theme: 29. Rehabilitation and Sports Cardiology
Subtheme: 29.2 Cardiovascular Rehabilitation
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Mariana Sousa Paiva; Rita Reis Santos; Sara Guerreiro; Gonçalo l. Cunha; Daniel a. Gomes; Rita Amador; Rita Lima; Rita Bello; Sofia Santos; Mónica Neto; Maria la Salete Pinto; Luís Moreno; Anaí Durazzo; Miguel Mendes

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Background</span></strong><span style="font-family:Times">: </span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">The pandemic raised interest in digital methods to manage and prevent cardiovascular diseases. Thus, cardiac rehabilitation programs (CRP) were adapted, with a marked increase in the delivery of home-based programs. The aim of this study was to evaluate and compare the center-based (CB), hybrid (HyB) and home-based (HB) CRPs developed in our center.</span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Methods</span></strong><span style="font-family:Times">:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">Single center cohort study of consecutive patients that accepted to join a two-month CRP from April 2019 to September 2021. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">The CB-CRP, as standard of care, involved 20 supervised exercise sessions, the HyB-CRP included a 2-week program (6 sessions) at the hospital, followed by digital follow-up and counselling, and the HB-CRP was exclusively based on digital platforms and regular phone consultations.&nbsp;</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">Data on medical history, lifestyle, and blood analyses, before and after the program, were collected from electronic charts.&nbsp;</span></span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">All CV risk factor control goals were defined accordingly to the ESC guidelines.</span></span></span></span></span></span></span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Results</span></strong><span style="font-family:Times">:</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">In total, 133 patients were enrolled, but only 105 completed the program, as 23 patients dropped out from the HB-CRP, 3 from the HyB-CRP and 2 from the CB-CRP &ndash; <strong>Fig. 1</strong>.&nbsp;&nbsp;</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">The mean age was 60&plusmn;11 years, 71% were male, the majority (88%) was referenced after an acute coronary syndrome and 72% had preserved left ventricular ejection fraction. </span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">Baseline risk factors were similar between the 3 groups: systolic blood pressure (SBP) (mean 118&plusmn;16 mmHg) was controlled, but BMI (median 27 (IQR: 24-31) kg/m<sup>2</sup>), LDL-C values (median 61 (IQR: 47-83) mg/dL) and physical activity (69% of inactive patients) were uncontrolled. Also, there were 18% of active smokers.&nbsp;&nbsp;</span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">At the 2-month follow-up, LDL-c values (median 56 (IQR: 44-73) mg/dL), percentage of inactive patients (49%) and active smokers (16%) dropped, while median BMI stood at the same level (27 (IQR: 24-31) kg/m<sup>2</sup>). Compared with the standard of care, the digital programs yielded worse results: the HyB-CRP in terms of LDL-C values control (35% vs. 60%, p=0.04) and the HB-CRP in terms of percentage of inactive patients (76% vs. 34%, p=0.004). However, for BMI, SBP and smoke cessation, the results were similar between the 3 groups.</span></span></span></span></span></p>

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<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Conclusion</span></strong><span style="font-family:Times">:&nbsp;</span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Times">Overall, our programs had a positive impact on risk factor control. However, patients in the digital programs are a challenge for the CRP team, since they are more likely to drop out, less willing to engage healthy behaviors and showed lower CV risk factors control. A stronger approach must be attended to ameliorate the outcomes in the hybrid and home-based programs.</span></span></p>