Is it time to Permanently transition to Home-based Cardiac Rehabilitation after COVID-19?

s American Journal of Preventive Cardiology 3 (2020) 116 AMERICAN JOURNAL OF PREVENTIVE CARDIOLOGY 3 (2020) 100051 IS IT TIME TO PERMANENTLY TRANSITION TO HOME-BASED CARDIAC REHABILITATION AFTER COVID-19? Mayur Patel, MD, Marcelle Trombley, Andrea Arrom, Martha Gulati, MD MS. University of Arizona-Phoenix/Banner University Medical Center, Department of Cardiology Abstract Topic: Cardiac Rehabilitation Lead Author’s Financial Disclosures: None Background/Synopsis: Exercise-based cardiac rehabilitation (CR) has been well established in reducing cardiovascular mortality and hospitalizations and improving health-related quality of life in adults with ischemic heart disease, heart failure, or following cardiac surgery. Though medically supervised, centerbased CR (CBCR) is the current standard of care, the impact of this intervention is limited by referral, enrollment, and retention gaps among the majority of eligible patients. The COVID-19 pandemic has exacerbated these deficiencies and created another barrier for CBCR programs, leading many to question its effectiveness for future implementation. Methods: A single-center, retrospective analysis was conducted to evaluate the level of participation in phase II/III center-based cardiac rehabilitation over the past year, including the first month after the US COVID outbreak.. Results: Data concerning the total number of completed sessions per month and the number of new phase II patient evaluations per month were compiled from January 2019 to March 2020 at the Banner University Medical Center Cardiac Rehabilitation Center (Figure 1 and 2). On average during this period, there were approximately 555 completed sessions per month and 18 new phase II patient evaluations per month. The COVID-19 outbreak halted our CBCR on March 16th, 2020 resulting in 53% reduction in completed sessions and 61% reduction in new phase II patient evaluations. Conclusions: Our data confers with national registries that even prior to COVID19, low referral, enrollment, and completion rates were established barriers to CBCR. Major limitations include lack of transportation, competing time demands, lack of insurance coverage, and inability to afford co-payment charges. The COVID-19 pandemic has compounded these limitations further, which will only continue to propagate as a result of mitigation strategies. The impact of the lack of CR remains to be assessed. Home-based CR (HBCR) is a cost effective, safe method that has shown to be just as effective as CBCR in reducing cardiovascular mortality and morbidity. Other countries have also shown increased enrollment and adherence with HBCR. Therefore, irrespective of a pandemic, HBCR should be considered as a delivery method for cardiac rehabilitation moving forward.