Cardiac Rehabilitation in Canada during COVID-19

Marzolini, Susan; Ghisi, Gabriela Melo; Hébert, Andrée-Anne; Ahden, Shobhit; Oh, Paul

BACKGROUND: /Methods: To examine the status of cardiac rehabilitation programs (CRPs) during COVID-19, a web-based questionnaire was completed by CRP managers from April 23(rd)-May 14(th) 2020. RESULTS: Overall, 114 representatives of 144 CRPs (79.1% of Canadian programs) responded. Of respondents, 41.2% (n=47) reported CRP closure; primary reasons were staff redeployment and facility closure (41% of 51 responses, both). Redeployment occurred in open-CRPs and closed-CRPs (30±34% and 47±38% of employees respectively;p=.05) and reduced hours in 17.8±31% and 22.5±33% of remaining employees;p=.56. Of open-CRPs, 84.8% accepted referrals for medically high-risk patients pre-COVID-19; falling to only 43.5% during-COVID-19;p<.001. There was a significant reduction in patients with cognitive/communication/mobility deficits being eligible to participate during-COVID-19. Of respondents, 57%-82.6% reported safety concerns for prescribing exercise to medically high-risk and vulnerable populations. CRPs transitioned from group-based to one-to-one delivery models; >80% by phone and/or e-mail. Any tele-rehabilitation (one-to-one/group) was also used by 32.7% and 43.5% of CRPs to deliver exercise and education respectively (mostly one-to-one). Resource barriers cited by open- and closed-CRPs were related to technology; no tele-rehabilitation, lack of equipment and patient access (35% of all barriers) while 25.3% of barriers were owing to greater demands on staff time. CONCLUSION: Within 2-months of COVID-19 being declared a pandemic, 41.2% of CRPs were closed and almost half of employees redeployed. Less time-efficient one-to-one models of remote care mostly by phone/e-mail were adopted. Vulnerable populations were disproportionately affected becoming ineligible owing to safety concerns. Strategies to open closed-CRPs, admitting high risk/vulnerable populations, and offering group-based tele-rehabilitation should be a national priority. BRIEF SUMMARY: An increase in patients with complex cardiac conditions referred to cardiac rehabilitation programs (CRPs) is expected given delayed treatment and cardiac involvement related to COVID-19. Yet, ∼half of employees were redeployed and 41% of Canadian CRPs closed. There was a marked decrease in open-CRPs accepting referrals for high medical-risk and vulnerable patients. Developing policy that provides strategies to open closed-CRPs, admitting high risk/vulnerable populations, and offering group-based tele-rehabilitation should be a national priority.