Undergraduate Research Student Western University Mississauga, Ontario, Canada
Background: Patients who undergo coronary artery bypass grafting (CABG) for multi-vessel coronary artery disease benefit from cardiac rehabilitation (CR) to regain mobility and reduce the risk of recurrent cardiovascular events. CR is a medically supervised program with exercised training, nutritional counselling, behavioural modification, and psychosocial support. In 2020, the COVD-19 pandemic disrupted delivery of healthcare systems, including CR, and prompted the transition from in-person to virtual CR at St. Joseph’s Health Care (SJHC) in London, Ontario. This single-centre study aims to investigate the impact of transitioning from in-person to virtual CR during the COVID-19 pandemic on both program and patient outcomes in post-CABG patients.
METHODS AND RESULTS: This retrospective cohort study included consecutive post-CABG patients who attended their CR intake appointment before (PRE: 2017 to 2019) and during the pandemic (PAN: 2020 to 2022). Program outcomes included CR enrolment, referral-to-intake wait times and program completion rates. Patient outcomes included changes in metabolic equivalent of tasks (METs), low-density lipoprotein cholesterol (LDLc), hemoglobin A1c (HbA1c), and weight after CR. A significance level of 0.05 was used. Overall, 584 patients were included in the study (Figure 1). CR enrolment declined 35% from 355 patients (80 females) before the pandemic to 229 patients (41 females) during the pandemic. Virtual CR during the pandemic (PAN) experienced a 34% reduction in referral-to-intake wait times (median: 40 days vs 61 days; p < 0.0001), while program completion rates were similar (82% vs 79%). As shown in Figure 2, virtual CR during the pandemic (PAN) was associated with reduced improvement in METs (+0.95 vs. +1.29, p < 0.05), greater reduction in LDLc levels (-0.265 mmol/L vs -0.04 mmol/L vs; p < 0.01), and less weight gain (+0.53kg vs. +1.66kg; p < 0.05), compared to conventional in-person CR. Although virtual CR showed a smaller improvement in METs, it still met the Canadian Cardiovascular Society’s guidelines threshold of ≥ 0.5 increase in METs. There was no effect on HbA1c.
Conclusion: Despite a decline in CR enrolment in post-CABG patients during the pandemic, virtual CR was associated with shorter wait times and similar completion rates compared to pre-pandemic. Virtual CR was associated with mixed effects on patient outcomes; for example, less improvement in exercise capacity may temper the improved mortality associated with CR, despite greater improvement in LDLc. Further research is needed to evaluate the impact of virtual CR on mortality and cardiovascular events in post-CABG patients.
