Speakers
Prof. Sherry Grace
York University, Canada
Sherry L. Grace, PhD, FCCS, FAACVPR, CRFC is Full Professor at York University, Toronto; She is also appointed at the University Health Network as Sr. Scientist and Director of Cardiac Rehabilitation Research.
Prof. Grace’s research centers on optimizing access to quality post-acute cardiovascular care globally. She has published >300 papers, and is among the top 2-3% most-cited researchers globally. She has led the development of cardiac rehabilitation clinical practice guidelines, quality indicators and global surveys, as well as position statements on systematic referral and utilization interventions.
Prof. Grace has earned awards from the American and Canadian Associations of Cardiovascular Rehabilitation, among other societies. Finally, she was instrumental in the development of the International Council of Cardiovascular Rehabilitation and Prevention, including leading their global cardiac rehab audit, and serving as co-chair of their certification program and new registry.
Abstract
Cardiac rehabilitation around the world during the COVID pandemic
The (1) early and (2) late impacts of COVID-19 on CR delivery around the globe, including effects on providers and patients, as well as (3) implications and recommendations for delivery in the current peri-COVID era will be described. Through a cross-sectional study, a piloted survey was administered to CR programs globally early in the pandemic. The 50 members of the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) facilitated program identification. Given known availability of CR, results suggest that approximately 4400 programs would have ceased service delivery globally. Alternative models were delivered in 40% of programs, primarily through low-tech modes (19%). 30% of respondents were re-deployed, and 37% felt the need to work due to fear of losing their job. 23% reported anxiety, 20% were concerned about exposing their family, 10% reported increased workload to transition to remote delivery, and 9% were juggling caregiving responsibilities.
Data from cardiac patients suggests the COVID waves are impacting their psychosocial well-being, and many have experienced major life stressors. In terms of heart-health behavior, there has been less exercise due to confinement, with associated weight gain, as well as increased substance use. Patients are avoiding preventive care visits and are having difficulty refilling prescriptions. This has resulted in worsening cardiac symptoms and risk factors, while at the same time these patients are often now needing to pay for remote CR as it is not reimbursed.
In the current era, we need to better understand the number of operating programs, through a repeat of ICCPR’s Global Audit. We do know that programs that remain open are implementing new technologies to ensure their patients receive CR safely, despite the challenges such as access, digital literacy, cost, connectivity, and engagement. Safety protocols for remote exercise have been tried. Indeed, home-based CR is shown to be as safe and effective as centre-based.