Cardiac Telerehabilitation by Asθenis

Cardiovascular diseases (CVDs) are the leading cause of death globally. Additionally, studies have shown that Covid -19 can further increase a person’s cardiovascular risk. Exercise-based Cardiac Rehabilitation (CR) is a comprehensive secondary prevention program designed to improve cardiovascular health following a cardiac event or procedure. An optimal Cardiac Rehabilitation experience consists of 36 one-hour sessions that include team-based supervised exercise training, education and skills development for heart-healthy living, and counseling on stress and other psychosocial factors (Mayo Clinic Proceedings, 2016). Participation in a CR program can reduce the risks of death from any cause and from cardiac causes, as well as, decrease hospital readmissions. CR participation also improves functional status, quality of life, mood, and medication adherence.

Despite these benefits, participation in CR remains low, due to the lack of specialized centers. Apart from low economic funding of National Health System due to recession, one of the factors that increase the inequality in access to health services is the geographical specificity of our country which includes many islands. Residents of remote areas, small and isolated islands have problems accessing specialist doctors and specialized laboratory centers. Citizens, especially those with health problems, are forced to move to urban centers where appropriate services are available.

Taking into account all the above, the General Hospital ‘Asklepieio Voulas’ in Greece, in association with the 2nd Regional Healthcare Administration (RHA) of Piraeus and the Aegean Islands has developed an exercise-based Cardiac Telerehabilitation program in order to increase the enrolment and the participation of eligible patients to cardiac rehabilitation services.
At General Hospital Asklepieio Voulas, the Physical Therapy department in collaboration with the Cardiology clinic, has established a Cardiac Rehabilitation section that offers, after thorough medical and physical assessment, a structured, supervised, individualized exercise program to cardiac patients. Through this innovation, the specialized healthcare professionals of Cardiac Rehabilitation section will be able to offer high quality specialized CR services to residents of remote areas.

The objectives of this innovation are to:

• Increase the enrollment and participation in CR services.
• Improve the cardiovascular disease management and reduce cardiovascular risk.
• Reduce hospital readmissions and referral to urban centers.
• Meet the growing needs of the population adopting cost effective national strategies.

This innovative pilot attempt can be used as guide to further evolve hybrid models of health services in the future, in order to increase the access in specialized health centers with cost effective strategies. Additionally, this innovation will offer the opportunity to collect data and extract relevant information that promotes scientific multidisciplinary research in cardiovascular diseases.
Telerehabilitation is a branch of telemedicine in which information and communication technologies are used to directly provide remote rehabilitation activities.

Provision of Cardiac Rehabilitation has been directly impacted by coronavirus disease and the measures implemented, highlighting the need to develop telerehabilitation and telemedicine services in order to allow continuity of care for patients who can benefit from remote consultations, while ensuring greater protection for those who are members of vulnerable groups. Thus, we were inspired to develop a sophisticated, well-structured Cardiac Telerehabilitation program aiming to offer in real time the specialized service of our hospital in more remote centers with low cost.

Telehealth use has risen dramatically as health systems look for ways to provide care while protecting providers and patients during the COVID-19 pandemic. In spite of the devastating effect of COVID-19, heart disease remains the number one death cause among adult men and women in the world. However, the big majority of patients do not follow the prescribed rehabilitation. The main reasons for this lack of compliance are simple motivation and limited access. Outpatient facilities are not always accessible, particularly for those in rural or island areas. Fortunately, virtual medical care – telehealth – directly addresses these issues. However, there is no service available in order to provide real time monitoring cardiac telerehabilitation. Our innovation consists of a specialized software that restores patients’ data and records real time vital signs. Our experienced department can monitor CR sessions in remote hospitals without specialized CR departments, with low cost.

Telerehabilitation is a branch of Telemedicine in which information and communication technologies are used to directly provide remote rehabilitation activities. So, we had the idea to develop tele-rehabilitation services for cardiac patients who cannot have easily access to our CR department. The CEO of our hospital, suggested to develop and apply tele-services to the cardiac patients of the islands of the the 2nd Regional Healthcare administration (RHA) of Piraeus and the Aegean Islands and in collaboration with other Public Hospitals that already have a Cardiac clinic but not Cardiac Rehabilitation section. In collaboration with the ‘asθenis’ (an experienced provider of digital solutions) we have designed and developed a sophisticated, adapted to our needs, software in order to provide supervised individualized exercise-based CR in real time to remote hospitals participating to the National Telemedicine Network.

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