Practice of cardiac rehabilitation at the beginning of the COVID-19 pandemic: Challenges and responses

Despite the upheavals in health care systems related to the onset of the COVID-19 pandemic, cardiac rehabilitation (CR) needs to continue for inpatients experiencing recent cardiac surgery or severe heart failure because CR improves patient outcomes, reduces readmissions and lowers long-term costs. Our aim is to share the strategies implemented in our facility to minimize the risk of COVID-19 transmission and thus ensure safe and efficient CR for the inpatients. We describe the guidelines that were applied in our cardiac rehabilitation unit (CRU) during the containment phase in France, from March 17 to May 11, 2020. We report the incidence of COVID-19 confirmed cases by RT-PCR testing among symptomatic inpatients and health care workers (HCWs) within the same timeframe. Our strategy was focused on isolation of all inpatients and protection of the professionals. The main measures were systematically placing admitted patients in a single room, generalizing the use of surgical masks for HCWs and inpatients, suspending day hospital activity. The CR program was based on individual exercise and education, plus collective activities involving 2 or 3 patients with respect of enhanced barrier measures. From March 17, to May 11, 2020, 97 patients have been hospitalized in the CRU. The average length of stay was 24 days. Five members of the health care staff (5/205, 2.4%) were suspected cases and all tested negative for COVID-19. Eighteen inpatients (18/97, 18%) tested for COVID-19 and 2 (2/18, 11%) tested positive. Patient No. 1 had a positive test 10 days after her admission to the CRU. Patient No. 2 tested positive on the day of his admission. Both had recent cardiac surgery. They were transferred back to the hospital. No secondary case was detected in the CRU. CR can be performed in a safe way for both inpatients and HCWs during the COVID-19 pandemic era. In our experience, strict isolating and protecting measures are efficient to avoid nosocomial SARS-CoV-2 spread in CRUs.