Background: 

The Corona-19 epidemic has decreased drastically the number of physical visits to the hospital, and therefore, the follow-up of the patients with chronic diseases has been drastically replaced by telephone calls. This fact has reduced the quality of CR services by reducing accessibility and equality to the programs and by hindering the multidisciplinary communication into the CR team. The utilization of the digital technology increases accessibility, continuity in care with at least as good results as traditional. In particular, the use of digital technology enables the transition from a traditional center-based model to a more person-centered, flexible, and equal model of home-based CR. Likewise other hospitals in Sweden and Europe, most post-infarction patients from outpatient services of the Heart Clinic, at the Norrland´s University Hospital (NUS), have undergone CR via telephone consultation. This has been perceived as a non-optimal situation by patients and healthcare professionals. The present project represents an effort to establish alternative ways of delivering CR by using digital means. Thus, we propose the utilization of an online CR (O-CR) program.

General objective: To evaluate all user´s satisfaction levels, and the standardized outcome measures (the so called SEPHIA register), after the implementation of an online CR program for 6 months.

Specific objectives:

1.    To measure satisfaction levels of implementing O-CR in all users (patients and the multidisciplinary staff) 

2.    To compare users' satisfaction levels between the traditional and the O-CR.

3.    To analyze blood pressure, lipids, smoking and physical activity/exercise outcomes (included in the SEPHIA-registry) in all participants after 6 months of using the O-CR

Activities 

To achieve the objective 1 and 2, we will conduct in-depth interviews (for the staff) and specific questionnaires designed for the measuring of satisfaction levels in the implementation of digital technology (for patients and staff). 

To achieve the objective 3, the pre- and post- intervention SEPHIA´s health measures will be analyzed, and compared with an age and sex matched control group selected from the traditional CR program that did not receive the O-CR.

Study design, setting and study population

Quasi-experimental prospective study. The O-CR (the intervention) will be offered to patients with cardiovascular disease at discharge who voluntarily want to test the O-CR in addition to their traditional (center-based) program. A pre- post experimental design will be applied to fulfil objectives 2 and 3.

We will conduct this project at the Cardiac Rehabilitation Services, Norrland´s University Hospital, Umeå.

The patients will undergo O-CR from their respective homes, in communication with the staff involved in this study.

20 patients who fulfill the inclusion criteria will have the opportunity to test the online program during 6 months from the hospital discharge time. 

Inclusion criteria:

1. Patients who recently have been discharged from the hospital after an ischemic heart event and suitable for center-based HR. 

2. Stable and asymptomatic at the time of inclusion 

3. Patients speak Swedish, can manage Internet, and manifest their willingness to follow the online program for at least 6 months.

Exclusion criteria: 

1.    Comorbidities, physical or mental diseases which may compromise the following of the online program.

Staff:

• 1 cardiologist 

• 1 cardiac nurse

•  1 physiotherapist 

• 1 use experience designer (Ux designer) 

Preliminary results

In the fall 2021, a preliminary study with 6 volunteers from the Heart & Lung Association Region Västerbotten has been conducted. In this study, a commercial communication platform (NUITEQ) has been utilized by a cardiologist, a nurse and a physiotherapist to arrange meetings following the current structure of a hospital-based program. The team has also the possibility to test a questioning system for comprehensive anamnesis, denominated as “the MENTOR-program”, and also conducted a group educational session – The Heart School-

The preliminary results of this study will be shared at Vitalis.