Although cardiac rehabilitation can make a tremendous impact on secondary prevention after cardiac events and procedures, a significant number of eligible patients don’t receive it. That’s because the in-person nature of most programs requires patients to commute to cardiac rehab centers typically three times each week — often driving a significant distance, paying for parking and sacrificing critical work or family time, says Johns Hopkins preventive cardiologist Seth Martin.
“It’s a big commitment that has prevented many of our patients from accessing care,” Martin says. “And that was before the pandemic hit.”
In March 2020, Johns Hopkins’ cardiac rehab program and most others across the country halted in-person appointments, interrupting an estimated 3.3 million sessions for patients nationwide. The good news, says Martin, is that he and his colleagues — including cardiologists Lena Mathews and Kerry Stewart — had been researching and developing a plan for virtual cardiac rehab as a path to broaden access and boost health equity long before COVID-19 surfaced. The pandemic served as a catalyst for these plans, he explains, condensing months or years of work into just a few weeks.
On April 1, 2020, Martin and his colleagues received funding from the American Heart Association for a research grant they’d submitted months before to develop a virtual cardiac rehab program at Johns Hopkins. Immediately, they assembled a team with a wide range of expertise, including cardiologists and nurses, exercise physiologists, digital health innovators, and law and compliance specialists. Together, the members of this group developed a new curriculum for virtual rehab that takes advantage of some existing platforms they were studying, such as an app that Martin and his colleagues developed and have been researching to help heart attack patients take charge of their recovery.
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In addition to customizing this established digital health platform for virtual cardiac rehab, the researchers established criteria for deciding which patients would safely benefit from a virtual program. They also digitized paper intake and progress forms to build a database of patient information, and developed videos to help onboard patients. To narrow the digital divide and make the program more widely accessible, Martin and his colleagues worked with industry partners to secure smartphones, smartwatches and internet access.
Patients are a pivotal part of the development team, says Martin. They help to inform the program by using the human-centered design method, in which feedback is solicited from those who will eventually use the virtual platform process through focus groups and other methods. Law and compliance experts are working on making this model sustainable with regard to payment.
Martin says he and his colleagues are looking forward to recruiting patients to help further develop and test the virtual approach to cardiac rehab, a next step for this research that they hope to take soon. If successful, he adds, virtual cardiac rehab could change care long beyond the pandemic.
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