Facility-based and virtual cardiac rehabilitation in young patients with heart disease during the COVID-19 era

Background Cardiac rehabilitation (CR) is an important tool for improving fitness and quality of life in those with heart disease (HD). Few pediatric centers use CR to care for these patients, and virtual CR is rarely used. Additionally, it is unclear how the COVID-19 era has changed CR outcomes. Objectives This study assessed fitness improvements in young HD patients participating in both facility-based and virtual CR during the COVID-19 pandemic. Methods This retrospective single-center cohort study included new patients who completed CR from March 2020 through July 2022. CR outcomes included physical, performance, and psychosocial measures. Comparison between serial testing was performed with a paired t-test with P<0.05 was considered significant. Data are reported as mean±standard deviation. Results There were 47 patients (19±7.3 years-old; 49% male) who completed CR. Improvements were seen in peak oxygen consumption (VO 2 , 62.3±16.1 v 71±18.2% of predicted, p=0.0007), 6-minute walk (6MW) distance (401±163.8 v 480.7±119.2 meters, p=<0.0001), sit to stand (16.2±4.9 v 22.1±6.6 repetitions; p=<0.0001), Patient Health Questionnaire-9 (PHQ-9) (5.9±4.3 v 4.4±4.2; p=0.002), and Physical Component Score (39.9±10.1 v 44.9±8.8; p=0.002). Facility-based CR enrollees were less likely to complete CR than virtual patients (60%, 33/55 v 80%, 12/15; p=0.005). Increases in peak VO 2 (60±15.3 v 70.2±17.8 % of predicted; p=0.002) were seen among those that completed facility-based CR; this was not observed in the virtual group. Both groups demonstrated improvement in 6MW distance, sit-to-stand repetitions, and sit-and-reach distance. Conclusions Completion of a CR program resulted in fitness improvements during the COVID-19 era regardless of location.