HYBRID CARDIAC REHABILITATION: EARLY EXPERIENCE FROM RECRUITMENT TO GRADUATION

• Published in: American journal of preventive cardiology 2023-03, Vol.13, p.100417, Article 100417
• Main Authors: MacFarlane, Zane T., Isakadze, Nino, Broderick, Ashley, Bush, Alexandra, Gao, Yumin, Spaulding, Erin M., Gallagher, Jeanmarie, Benjamin, Preeti, Neigh, Brittany, Lee, Matthias, Sham, Jeffrey, Stewart, Kerry J., Mathews, Lena, Martin, Seth S., Marvel, Francoise A.
• Format: Article
• Language: English
• ISSN: 2666-6677; 2666-6677
• DOI: 10.1016/j.ajpc.2022.100417

EMS serves as a consultant to Corrie Health. Under a license agreement between Corrie Health and the Johns Hopkins University, the University owns equity in Corrie Health and the University, FAM, and SSM are entitled to royalty distributions related to technology described in the study discussed in this publication. Additionally, FAM and SSM are founders of and hold equity in Corrie Health. ML and JS have equity ownership in Corrie Health. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict-of-interest policies. Cardiac Rehabilitation; Secondary Prevention of CVD; Digital Health Low participation in cardiac rehabilitation (CR) is a missed opportunity to improve outcomes in secondary prevention of cardiovascular disease. To increase participation in CR, a multidisciplinary team launched a 12-week hybrid CR program utilizing in-center and virtual CR sessions via an evidence-based digital health platform. Our early experience with >40 participants provides valuable lessons learned for creating a scalable hybrid CR program. We established a 5-phase approach from recruitment to graduation. Phase 1 - Pre-Bedside: We used the electronic medical record system, Epic, to identify low to moderate risk CR-eligible inpatients. Phase 2 - Bedside: Patient navigators approached inpatients to inform them about hybrid CR, conduct further screening, and for enrollment. Patients were coached how to use the digital health platform including a smartphone application, smartwatch, and blood pressure monitor. Phase 3 - Pre-CR: During hospitalization and after discharge, patients tracked medication use and vital signs, engaged with educational videos, and entered lab values (ex. LDL). Coaches conducted weekly check-in sessions to review progress, safety, and address any technical issues. Phase 4 - CR: Patients completed 2 in-center safety assessments prior to starting home-exercise. Phase 5 - Graduation: Patients received a graduation coaching session at week 12 to celebrate and plan for sustainable healthy lifestyle habits. We identified multiple areas for improvement and enhanced our program. Phase 1: We streamlined patient identification using Epic reports and auto-referral ordersets for eligible patients. Phase 2: We developed flexible onboarding methods with instructional videos tailored for different levels of digital literacy. We also found that assembling a diverse CR team was key for recruiting patients traditiona