This article is part of Cardiology Advisor‘s coverage of AHA Scientific Sessions 2020.

Virtual or remote telehealth cardiac rehabilitation programs implemented during the coronavirus disease 2019 (COVID-19) pandemic were found to maintain levels of patient acceptance, adherence, as well as referral observed with in-person outpatient rehabilitation programs, according to study results presented at the American Heart Association (AHA) Scientific Sessions 2020, held virtually from November 13 to 17, 2020.

A nationwide lockdown was set in place in Canada on March 17, 2020, in an effort to contain and prevent the spread of COVID-19. As a result, the Central East Cardiovascular Rehabilitation center in the Eastern Greater Toronto area transitioned from an on-site cardiac rehabilitation program to a virtual program within 1 week. The virtual program included telehealth visits conducted via telephone, email, mobile apps, and web-based video programs. Researchers from this center compared access and completion of this virtual program with a matched 6-week period the preceding year (ie, March 16 to April 24, 2019).

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Total referrals increased by 32.8% during the lockdown period compared with the matched 2019 period. However, community referrals were reduced by 87.7% in 2020 compared with 2019. Attendance was found to be stable during the virtual rehabilitation program. Attendance rate vs scheduled was 85% of the matched 2019 period, and patient acceptance rate was >90%. Only 9% of patients declined participating in the virtual cardiac rehabilitation program.

A limitation of the virtual program, the doubling of related costs compared with onsite delivery, an increase which was primarily attributable to increases in staff costs related to higher numbers of 1-on-1 patient consultation.

“We anticipated that the pandemic response would negatively impact referral, acceptance and completion rates,” noted the lead study author Joseph A. Ricci, MD, of the Central East Cardiovascular Rehabilitation Program in Toronto. “Based on this experience, modern technologies should be integrated into traditional delivery models beyond the pandemic period, including exploration of hybrid in-person, on-site and virtual rehabilitation programs.”


Ricci JA, Akbarali R, Tsui C, et al. Health care system design and virtual delivery system: cardiovascular rehabilitation access and participation rates during COVID19 public health emergency.  Presented at: AHA Scientific Sessions 2020; November 13-17, 2020. Presentation P2365.

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