Cardiac Rehabilitation in Canada During COVID-19

BACKGROUND: Cardiac rehabilitation programs (CRPs) had to change quickly in response to a shift in clinical priorities related to to the coronavirus disease 2019 (COVID-19). Yet, no study has examined the effect of COVID-19 on CRPs and if there has been an adequate transition to alternative programming. METHODS: To examine the status of CRPs during the COVID-19 pandemic, a web-based questionnaire was completed by CRP managers from April 23rd to May 14th, 2020. RESULTS: Overall, 114 representatives of 144 CRPs (79.1% of Canadian programs) responded. Of respondents, 41.2% (n = 47) reported CRP closure; primary reasons were staff redeployment and facility closure (41% of 51 responses, for both). Redeployment occurred in open CRPs and closed CRPs (30% ± 34% and 47% ± 38% of employees, respectively; P = 0.05) and reduced hours in 17.8% ± 31% and 22.5% ± 33% for remaining employees; P = 0.56. Of open CRPs, 84.8% accepted referrals for medically high-risk patients pre-COVID-19; this level fell to only 43.5% during the COVID-19 pandemic, P < 0.001. There was a significant reduction in patients with cognitive/communication/mobility deficits who were eligible to participate during the COVID-19 pandemic. Of respondents, 57%-82.6% reported safety concerns related to prescribing exercise to medically high-risk and vulnerable populations. CRPs transitioned from group-based to one-to-one delivery models—>80% by phone and/or e-mail. Any tele-rehabilitation (one-to-one/group) was also used by 32.7% and 43.5% of CRPs to deliver exercise and education, respectively (mostly one-to-one). Resource barriers cited by open and closed CRPs were related to technology—no tele-rehabilitation, lack of equipment and patient access (35% of all barriers)—and 25.3% of barriers were owing to greater demands on staff time. CONCLUSIONS: Within 2-months of COVID-19 being declared a pandemic, 41.2% of CRPs were closed and almost half of employees redeployed. Less time-efficient one-to-one models of remote care, mostly by phone/e-mail, were adopted. Vulnerable populations were disproportionately affected, becoming ineligible owing to safety concerns. Strategies to open closed CRPs, admission of high-risk/vulnerable populations, and offering of group-based tele-rehabilitation should be a national priority.