(VP058) HYBRID CARDIAC REHABILITATION AS A LEGACY OF THE COVID-19 PANDEMIC

Background: Hybrid CR (cardiac rehabilitation) consists of multidisciplinary care, including exercise therapy, delivered through in-person and virtual care. Virtual care included synchronous and asynchronous delivery. The primary objective of this study was to describe patient characteristics, attendance, completion rates, and safety outcomes in a real-world Hybrid CR population. Secondary objectives included the evaluation of program efficacy on patients cardiometabolic risk profiles and cardiorespiratory fitness.

METHODS AND RESULTS: Prospective observational study of an initial cohort completing a tertiary hybrid CR program between September 2021 and January 2023. Patients who were enrolled in and discharged (completed or dropped out) during the study period were included. Only patients who completed the program and follow-up testing were included for analysis of the secondary objectives. Risk was defined by the AACVPR 2020 risk categorization. Continuous variables are presented as means with SD or medians with IQR. Student’s t-test was used for between group comparisons, χ2 test and McNemar’s test for categorical variables, and Wilcoxon’s matched pairs signed rank test for ordinal variables. A p-value < 0.05 was considered significant. 145 patients enrolled in the program with 74% (n=107) discharged during the study timeframe. The average age of patients was 65.2±11.2. The primary indications for enrolment were acute coronary syndrome (32%) and coronary artery bypass grafting (24%). Twenty-four (22%) were considered high risk. The most common risk factors were hypertension, observed in 70% (n=75), and ex-smoking in 38% (n=41) of patients. A median attendance of 12 classes (4, 24) was observed, with 46% (n=49) utilizing hybrid delivery by attending at least one virtual class. Hybrid attendees were more likely to complete the program compared to in-person only attendees. Of those who completed the program, 62% (n=66) took part in at least the recommended 24 weeks of CR. The median time in the program was 26.1 weeks (12.4,30.8). Comparing baseline to end of the program, a significant decrease in LDL (-0.25 mmol/L, p=0.03) was observed. A significant improvement in cardiorespiratory fitness was noted compared to baseline in METs achieved on exercise stress tests (EST) (1.04 METs, p< 0.0001). When stratified by hybrid and in-person only groups, only the hybrid group showed a significant improvement in METs (1.40 METs, p< 0.0001). One adverse cardiac event occurred during supervised sessions, clinically significant non-sustained ventricular tachycardia on EST.

Conclusion: Outcomes from this study suggest that interdisciplinary hybrid CR may be utilized successfully and safely to help patients reduce cardiovascular risk factors and improve cardiorespiratory fitness.