Delivering digitally enhanced cardiac rehabilitation during COVID-19 restrictions
Cardiac rehabilitation (CR) is one of the most clinically and cost-effective therapeutic interventions in cardiovascular disease management, resulting in reduced mortality and episodes of acute hospitalisation whilst also improving functional capacity and perceived quality of life. In March 2020, South Tyneside Cardiac Rehabilitation started to use a digital enhanced cardiac rehabilitation model.
Currently the average number of eligible patients taking up the offer of CR in England, Northern Ireland and Wales is 50%, of whom 77% will go on to complete a programme (National Audit of Cardiac Rehabilitation, 2019).
The NHS Long Term Plan (2019) sets out ambitions to increase this number to 85% by 2028. There are numerous reasons why people don’t take up the offer, but a key factor is accessibility. The British Association of cardiovascular prevention and rehabilitation (BACPR) have been calling on clinical services to look at alternative modes of delivery that maintain quality standards and patient outcomes, whilst providing greater flexibility.
The COVID-19 pandemic has significantly impacted healthcare delivery systems worldwide. Patients with pre-existing cardiovascular disease are deemed to be at increased risk of more severe complications of the COVID-19 virus and, as such, all face-to-face CR classes were suspended in March 2020.
South Tyneside Cardiac Rehabilitation Service examined how it could continue to support patients in spite of COVID-19 restrictions in place and decided to adopt a clinically-driven digital solution to facilitate remote service delivery and patient management.
Solution and impact
The South Tyneside team received training for the myHeart app at the beginning of March 2020 and immediately began using it to onboard patients and offer support.
myHeart is an app designed by clinical experts to support patients with cardiac conditions and the clinical teams looking after their care. The app is intelligent and tailors content to a patient’s diagnosis. It caters for patients with heart failure and coronary vascular disease at all points within the clinical pathway, including post-cardiac events (acute coronary syndrome / myocardial infarction) and pre/post intravascular (percutaneous coronary intervention) and surgical cardiac intervention (coronary artery bypass grafting / valve replacement and repair).
The app helps patients understand what has happened to them and empowers them, through education, to support lifestyle modification and risk factor management. myHeart also contains a full safety-gated and graduated cardiac rehabilitation programme that can be customised to the patient’s diagnosis and functional ability.
myHeart is a web-based app that can be accessed on almost any device that connects to the internet. Patients are provided with an interface tailored specifically to their requirements and data is then presented back to clinical teams via the clinical-user interface to support remote patient management at scale.
There are a range of features within the app that will configure based on the patient’s diagnosis and risk factors, including:
- education (diagnosis-specific)
- cardiac rehabilitation (exercise) programme
- the ability to track and monitor symptom scores and weight (heart failure only)
- lifestyle advice
- blood pressure and cholesterol and other risk factor tracking
- connectivity to leading body composition scales and blood pressure machines
- the ability to store electro-cardiogram (ECG) and echocardiogram (ECHO) reports
The Cardiac Rehabilitation Team based in South Tyneside began rolling the app out to patients in March 2020 and continued to support them via telephone to encourage use of the app and to set and review goals. This has enabled the service to continue to support their patient caseload and new referrals.
Since March 2020, 164 patients have been registered with myHeart by the South Tyneside team with positive feedback received from both the patients and the clinical team.
A review of the progress of patients who had been registered showed that overall there was a high level of patients reporting a clinical outcome or watching an educational video each month. Across all patients, the app reported that after an initial peak in events, there was a consistent level of activity after activation.
The South Tyneside team was quick to adapt to the challenges presented by the pandemic and have shown great resilience and innovation in their ability to adopt a new way of working in a time of crisis, making myHeart an integral part of their service delivery.
Find out more
Jane Stokes – rehabilitation and engagement lead
Simone Rowlands, Cardiac Rehabilitation Specialist Nurse, South Tyneside & Sunderland Foundation Trust
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