Risk factor outcomes following flexible delivery models in cardiac rehabilitation: rehabilitation in the real world

Abstract Background Cardiac rehabilitation (CR) is essential for secondary prevention, yet access remains limited by geographic, logistical, and personal barriers. International recommendations, including the Canadian Cardiovascular Society/Canadian Association of Cardiovascular Prevention and Rehabilitation (CCC quality indicators) and the EuroPrevent/ASPIRE guidelines, emphasise equitable access and monitoring of cardiovascular disease (CVD) risk factor outcomes. CR programmes now offer flexible delivery options to expand access and support patient choice. Whether CVD disease risk factor outcomes differ between programme options in one of Canada’s largest CR centres warrants investigation. Purpose To evaluate CVD risk factor outcomes across patient-selected CR programme options (i.e., supervised vs. virtual case-managed). Methods A single-centre retrospective cohort study. At CR intake, patients self-selected one of two programme delivery models - supervised vs virtual case-managed. Patients who completed at least one baseline and end-of-program (EOP) risk factor measure (i.e., smoking status, physical activity, functional capacity, resting blood pressure, lipids, HbA1c, mental health, and fruit/vegetable intake) were included. Paired samples t-tests were conducted to determine differences in outcomes within models from baseline to EOP. Outcomes (baseline vs EOP) were compared between the delivery models using a repeated measures anova for continuous variables and controlling for sex and age, and a Chi-square test was conducted for categorical variables (i.e., smoking status) among patients in a CR programme at the University of Ottawa Heart Institute (UOHI) between 2023 and 2024. Results A total of 1,279 (31% female) patients enrolled in supervised CR (age: 66 ± 13.3 years) and 1,205 (33% female) in virtual case-managed CR (age: 67 ± 12.8 years). Of these, 745 and 788 patients completed intake and EOP assessments, respectively. No differences in risk factor outcomes were observed between programme choices (p=0.068); however, both sex and age were associated with EOP outcomes (p=0.005 and p0.001, respectively). Both options led to significant improvements in physical activity (supervised: 195 ± 171 to 231 ± 121 mins/week; virtual: 191 ± 177 to 211 ± 160, both p0.001) and METs (supervised: 6 ± 1.8 to 7 ± 1.8; virtual: 6 ± 1.8 to 7 ± 1.8, p0.001). Mental health scores (PHQ-9, GAD-7) also improved significantly (p≤0.004). No improvements in the other outcomes were observed. Conclusions Improvements in physical activity, functional capacity, and mental health were observed regardless of patient-selected CR programme option. Offering flexible models aligns with guidelines and supports patient-centred care to improve access and outcomes. Future work is warranted to evaluate patient autonomy and engagement when provided with CR programme choice.