Information and communication technology-based cardiac rehabilitation homecare programs

Abstract: Cardiac rehabilitation (CR) has, for many years, been a highly recommended approach to secondary prevention for patients recovering after a heart attack or heart surgery. These programs are traditionally delivered from a hospital outpatient center. Despite demonstrated benefits and guideline recommendations, CR utilization has been poor, particularly in women, older patients, and ethnic minority groups. To overcome some of the barriers to the traditional delivery of CR, different delivery platforms and approaches have been developed in recent years. In general, Telehealth solutions which have been used to address the delivery of CR services remotely include: 1) patient–provider contact delivered by telephone systems; 2) the Internet, with the majority of patient–provider contact for risk factor management taking place online; and 3) interventions using Smartphones as tools to deliver CR through (independently or in combination with) short message service messaging, journaling applications, connected measurement devices, and remote coaching. These solutions have been shown to overcome some of the barriers in CR participation and show potential as alternative or complementary options for individuals that find traditional center-based CR programs difficult to commit to. The major benefits of remote platforms for CR delivery are the ability to deliver these interventions without ongoing face-to-face contact, which provides an opportunity to reach large numbers of people, and the convenience of selecting the timing of cardiovascular disease management sessions. Furthermore, technologies have the potential to deliver long-term follow-up, which programs delivered by health professionals cannot afford to do due to staff shortages and budget restrictions. However, change in the existing CR services is not without challenges. There is a need to identify development issues that can hamper the implementation of the interventions outside controlled trial settings systems, which may require new computing infrastructures, specific clinical responsibilities, time for training, and development and openness to new ways of doing things. Keywords: cardiovascular disease, Telehealth, telephone, Internet, mobile phones