Integrated modern day digital solutions are the key to solving age old issues of poor cardiac rehab uptake, completion and preventable hospital readmissions.
The Sydney Morning Herald yesterday shone a spotlight on new research by the Baker Heart and Diabetes Institute, which recognised the importance of integrating digital health solutions into cardiac rehabilitation services to help more people recover from cardiac events and deliver greater impact.
The study sought to understand whether mhealth enabled Disease Management Programs (DMP’s), were effective in reducing readmissions and mortality in patients with heart disease. DMP’s are a framework for providing care for patients with cardiac disease and typically coordinated by nurses in collaboration with health care professionals. They commonly include heart health education; care coordination; exercise prescription; medication management and adherence; self-monitoring strategies; psychosocial support; behaviour change and goal setting.
The published literature review was conducted by researchers at the Baker Heart and Diabetes Institute, and lead by Snr author Assoc Prof Melinda Carrington Head of the Baker Institute’s Pre-Clinical Disease and Prevention unit. The study showed, there were clear and significant benefits regarding cardiac related hospital readmission reductions, all cause readmission reductions and reduced emergency department visits, when digitally enabled options were provided to patients. Equivalent results were observed in mortality and composite endpoints (MACE) for digital modalities compared to traditional models of care which today are perceived as the gold standard.
Assoc Prof Melinda Carrington suggests that while the study does not conclude tradition programs are less effective than digital, the impact lies in the fact that more patients can access and complete digital programs thanks to the flexibility and convenience afforded by the digital delivery format.
The research also highlighted the importance of providing patients with options of cardiac rehab programmes that can be accommodated into busy lives and that patients can commit to. The flexibility, convenience and personalisation which is enabled through technology based solutions has clear benefits, as opposed to the traditionally more fixed structures, time commitments and metropolitan locations of traditional clinic/gym based programs.
“We need to look at more modern day, alternative delivery methods of cardiac rehabilitation to increase access and engagement to improve the quality of life for people with heart disease and to reduce preventable and costly re-admissions to hospital.
“That’s why mobile health-enabled rehabilitation programs should be considered for improving outcomes in people with heart disease, allowing them to choose their preferred program type and setting”, says Assoc Prof Carrington.
Mr Brown who‘s personal experience was shared in the SMH article, explained how he benefited recently from Cardihab’s digitally enabled CR program and laments the missed opportunity from 20 years ago, where he received a stent after his first cardiac event, and set on his way home without CR.
Brown in his 80’s, found the six-week program he completed was helpful on a variety of levels. Each day, he entered his blood sugar levels, blood pressure and weight into the app, and was prompted to walk for 15 to 30 minutes.
He was also able to track what medications he was taking and when. “Half the time you can’t remember what you’re taking, and they change the names of medications,” he explains. “With this, I had a full record of all the medication I was taking and the amount. That was very helpful.”
The staggering reality, 20 years on, is that Mr Brown’s experience is still very common. While this time he was fortunate to have access to Cardihab’s digital CR program, the reality for the vast majority of people post cardiac event, is that they miss out. 80% of people who should participate in CR currently do not.
Clinical staff shortages, closures of cardiac rehabilitation services across Australia as a result of COVID measures and low levels of funding for cardiac rehab contribute significantly to the low availability and access to programs for patients who need them.
Rob Newton, a professor of exercise medicine and deputy director of Edith Cowan University’s Exercise Medicine Research Institute was not involved in the study, but was interviewed for the SMH article to comment on the findings.
“It is clear from the research that access is a major barrier to participation in cardiac rehab,” he says. “There is also a nationwide shortage of accredited exercise physiologists or appropriately qualified physiotherapists to assess, deliver and monitor the cardiac rehabilitation.”
For these reasons, he says: “Telehealth delivery of exercise medicine is increasingly demonstrating huge potential to address the chronic disease epidemic facing Australia.”
Read the publication in JACC 'Digital Health Programs to Reduce Readmissions in Coronary Artery Disease: A Systematic Review and Meta-Analysis'
Authors: Justin Braver, Thomas H. Marwick, Brian Oldenburg, Ayuba Issaka, and Melinda J. Carrington
Cardihab is the first and only digital therapeutic (DTx) for Cardiac Rehabilitation in Australia. Our clinically validated digital programs are delivered via a smartphone app that connects patients with healthcare professionals and allows patients to progress through their program at the time and place that suits them.
Cardihab is registered with the Australian Register of Therapeutic Goods (ARTG) and the only DTx in the world with a regulatory classification.