title: Improving access to cardiac rehabilitation using the internet: a randomized trial.
abstract: Cardiac rehabilitation (CR) is essential for secondary prevention, yet only 10%-30% of eligible patients attend as geographical proximity is a major barrier. We evaluated a 'virtual' CR program (vCRP) delivered by the Internet to patients in small urban and rural areas. In our study, in-patients (n=78) with acute coronary syndrome or post-revascularization were randomized to usual care (UC) or vCRP. The vCRP was a four-month program that included heart rate monitoring; physiologic data capture; education sessions; ask-an-expert sessions; and chat sessions with a nurse, exercise specialist and dietitian. Participants were assessed at baseline and four months, and followed for another 12 months. The primary outcome was change in maximal time on the treadmill stress test (MTT) between groups adjusted for age, sex, diabetes status and Internet use for health information. The vCRP resulted in a greater increase in MTT by 45.7 seconds (95% CI: 1.0, 90.5) compared to usual care (p=0.045). Cholesterol levels and dietary quality improved in the vCRP compared to the UC group. Participants perceived the vCRP to be an accessible, convenient and effective way to received healthcare. Eleven (30%) and 6 (18%) participants in the UC and vCRP groups, respectively, had cardiovascular-related events (p=0.275). In conclusion, the vCRP was safe and effective and resulted in sustainable risk reduction without the requirement of face-to-face visits and directly monitored exercise.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lear
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, Providence Health Care.
authors.forename: Joel
authors.initials: J
authors.lastname: Singer
authors.affiliation: School of Nursing, University of Northern British Columbia.
authors.forename: Davina
authors.initials: D
authors.lastname: Banner-Lukaris
authors.affiliation: Department of Family Medicine, Faculty of Medicine, University of British Columbia.
authors.forename: Dan
authors.initials: D
authors.lastname: Horvat
authors.affiliation: Department of Medicine, Faculty of Medicine, University of British Columbia.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Park
authors.affiliation: Department of Family Medicine, Faculty of Medicine, University of British Columbia.
authors.forename: Joanna
authors.initials: J
authors.lastname: Bates
authors.affiliation: Division of Cardiology, Providence Health Care.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ignaszewski
mesh_terms: D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000534:rehabilitation*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D015995:Prevalence; D012046:Rehabilitation / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data; D017216:Telemedicine / Q000706:statistics & numerical data*; D013813:Therapy, Computer-Assisted / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014584:User-Computer Interface