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Rhythmia Breath

Digital innovation in Cardiac Rehabilitation

Article by Health Innovation Network.

Gone are the days when clinicians rejected the idea that patients would use technology. Gone are the days when they believed technology could not improve outcomes. And gone are the days when clinicians worried about their job being taken by a robot. Now instead, clinicians are asking when they will get the digital tools they need to improve outcomes, efficiency and patient care. Well, at least this was the fantastic response we had from the London Cardiac Rehabilitation Network members’ recent Innovation Exchange event.

At the event, the challenges that cardiac services are facing were clearly set out by key opinion leaders Sally Hinton (BACPR Executive Director) and Patrick Doherty (Director of the National Audit for Cardiac Rehabilitation), along with patient representative Rob Elvins. The challenges they all raised were uptake and access. But they also highlighted the benefits of improving outcomes and uptake in this area too.

The NHS Long Term Plan (LTP) sets cardiac rehabilitation out as an intervention that can save lives, improve quality of life and reduce hospital readmissions. It’s also recommended by NICE. However, uptake of cardiac services currently varies widely across England and only 52% of the 121,500 eligible patients per year are taking up offers of cardiac rehabilitation. If we can increase this uptake to 85% by 2028, as set out by the LTP, it will prevent 23,000 premature deaths and 50,000 acute admissions over 10 years. Furthermore, it would make the NHS amongst the best in Europe. This suggests to me there is plenty of scope to improve services to the standard we all aspire to.

Many of the cardiac rehabilitation services present at the Innovation Exchange believed – as I do – that digital solutions are the only way they will manage to significantly increase uptake with current resources. Especially as uptake is lower in women, the young and those for whom it is their only health condition; a group of patients who might find digital or hybrid rehabilitation opportunities very attractive.

Many innovators applied to contribute to the event, which demonstrates the high level of interest and potential in this area. The selected innovators proved that many of these valuable digital solutions are not only already available, but they are comprehensive rehab programmes that are well-evidenced and could bolt onto existing services right now. There were also innovators with systems in other similar areas of care, that were willing to co-develop solutions for cardiac rehab. It was fantastic to see the energy that came from getting all the innovators both from services and those with potential solutions together. I am looking forward to seeing how the plans made develop over the coming months.

The Exchange closed with the panel discussing the way ahead for cardiac rehabilitation and the technology they would implement. Patrick Doherty summed discussions up by saying that you could no longer consider that you run a good cardiac rehab service unless you offered digital and home-based options for patients too. I don’t think anyone will have left the event without thinking the time has come for all cardiac rehabilitation services to have digital components, and many more of London’s cardiac rehabilitation services will be taking those important steps towards implementation.

Article published in https://healthinnovationnetwork.com/news/the-time-has-come/

 

Equally important is the following abstract:

The Delivery of Cardiac Rehabilitation Using Communications Technologies: The “Virtual” Cardiac Rehabilitation Program.

Cardiac rehabilitation (CR) programs are a proven therapy for patients with cardiovascular disease, reducing future cardiac events and premature mortality. However, as little as 10% of eligible patients attend these programs, with a key reason being geographical inaccessibility. In Canada, more than 90% of Canadians have Internet access, and there are approximately 31 million cell phone subscribers, with these numbers expected to continue to increase. The proliferation of these affordable communications technologies has opened up opportunities for patient communication while bridging the geographic distance. This has led to the development of “virtual” CR that can be remotely conducted, reaching patients in their homes and communities. These programs have used a range of technologies such as telephone, Internet, text messaging, and smartphones. Early research has focused on acceptance of use and feasibility in pilot studies, indicating patient willingness for use. More recently, a number of small, randomized trials have been conducted indicating a potential positive effect on various clinical outcomes. This narrative review highlights the evidence to date on the use of virtual CR, using a variety of affordable communications technologies from early feasibility studies to modest randomized controlled trials. Finally, lessons from previous studies are discussed to help inform the development and testing of future virtual CR. This will be important if virtual CR is to become part of standard health care.