TY - JOUR
T1 - Impact of Early COVID-19 Waves on Cardiac Rehabilitation Delivery in Australia
T2 - A National Survey
AU - Cartledge, Susie
AU - Thomas, Emma E.
AU - Murphy, Barbara
AU - Abell, Bridget
AU - Verdicchio, Christian
AU - Zecchin, Robert
AU - Cameron, Jan
AU - Gallagher, Robyn
AU - Astley, Carolyn
AU - on behalf of the ACRA COVID working group
N1 - Funding Information:
This study is the first to report the impact of COVID-19 on CR programs in Australia. A key strength of this study was reaching CR staff at a time of key change, when they could reflect on their current and previous practice. These results do come with several limitations, however. The main limitation is our small sample size due to a slightly lower than typical response rate (33%) (compared to between 47%–82% in previous similar CR survey studies) [ 9 , 27 , 31 ], and likely lack of representation of all Australian CR programs, particularly those in the private sector, despite having survey responses from every state and territory. This may be due to our recruitment methods, primarily relying on the ACRA membership network of CR clinicians, of which not all programs have members. However, the survey was promoted through other methods, including partner organisations with broad CR coverage. We hypothesise that non-responding programs may have been closed or having significant time and staffing constraints as a result of the pandemic. The sample size therefore limited us to predominantly descriptive statistics. Ideally, we would conduct a comparative analysis of program characteristics of responding programs to non-responding programs, however due to no current and complete national CR database or registry, this is not possible and is a limitation of current CR research in Australia. This gap is currently being addressed by the Synergy Grant from the National Health and Medical Research Council, for the SOLVE-CHD research group [ 32 ].
Funding Information:
S.C. and E.E.T. are supported by National Heart Foundation of Australia Postdoctoral Fellowships (# 104860 , # 105215 ).
Publisher Copyright:
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)
PY - 2023/3
Y1 - 2023/3
N2 - Background: The novel coronavirus disease of 2019 (COVID-19) pandemic significantly disrupted health care, especially outpatient services such as cardiac rehabilitation (CR). We investigated the impact of early COVID-19 waves on the delivery of Australian CR programs, comparing this time period with usual practice prior to the pandemic (2019) and current practice (2021) once the early waves had subsided. Specifically, we aimed to understand how the delivery of programs during COVID-19 compared to usual practice. Methods: An anonymous online cross-sectional survey of Australian CR program staff was conducted, comprising three sections: program and respondent characteristics, COVID-19 impact on program delivery, and barriers to, and enablers of, program delivery. Respondents were asked to consider three key timepoints: 1) Pre-COVID-19 (i.e. usual practice in 2019), 2) Early COVID-19 waves (March–December 2020), and 3) Currently, at time of survey completion post early COVID-19 waves (May–July 2021). Results: Of the 314 Australian CR programs, 115 responses were received, of which 105 had complete data, representing a 33% response rate. All states and territories were represented. During early COVID-19 waves programs had periods of closure (40%) or reduced delivery (70%). The majority of programs reported decreased CR referrals (51.5%) and decreased participation (77.5%). The two core components of CR—exercise and education—were significantly impacted during early COVID-19 waves, affecting both the number and duration of sessions provided. Exercise session duration did not return to pre-pandemic levels (53.5 min compared to 57.7 min, p=0.02). The majority of respondents (77%) reported their CR program was inferior in quality to pre-pandemic and more organisational support was required across information technology, staffing, administration and staff emotional and social support. Conclusion: Australian CR programs underwent significant change during the early COVID-19 waves, consistent with international CR reports. Fewer patients were referred and attended CR and those who did attend received a lower dose of exercise and education. It will be important to continue to monitor the long-term impacts of the COVID-19 pandemic to ensure CR programs return to pre-pandemic functioning and continue to deliver services in line with best practice and evidence-based recommendations.
AB - Background: The novel coronavirus disease of 2019 (COVID-19) pandemic significantly disrupted health care, especially outpatient services such as cardiac rehabilitation (CR). We investigated the impact of early COVID-19 waves on the delivery of Australian CR programs, comparing this time period with usual practice prior to the pandemic (2019) and current practice (2021) once the early waves had subsided. Specifically, we aimed to understand how the delivery of programs during COVID-19 compared to usual practice. Methods: An anonymous online cross-sectional survey of Australian CR program staff was conducted, comprising three sections: program and respondent characteristics, COVID-19 impact on program delivery, and barriers to, and enablers of, program delivery. Respondents were asked to consider three key timepoints: 1) Pre-COVID-19 (i.e. usual practice in 2019), 2) Early COVID-19 waves (March–December 2020), and 3) Currently, at time of survey completion post early COVID-19 waves (May–July 2021). Results: Of the 314 Australian CR programs, 115 responses were received, of which 105 had complete data, representing a 33% response rate. All states and territories were represented. During early COVID-19 waves programs had periods of closure (40%) or reduced delivery (70%). The majority of programs reported decreased CR referrals (51.5%) and decreased participation (77.5%). The two core components of CR—exercise and education—were significantly impacted during early COVID-19 waves, affecting both the number and duration of sessions provided. Exercise session duration did not return to pre-pandemic levels (53.5 min compared to 57.7 min, p=0.02). The majority of respondents (77%) reported their CR program was inferior in quality to pre-pandemic and more organisational support was required across information technology, staffing, administration and staff emotional and social support. Conclusion: Australian CR programs underwent significant change during the early COVID-19 waves, consistent with international CR reports. Fewer patients were referred and attended CR and those who did attend received a lower dose of exercise and education. It will be important to continue to monitor the long-term impacts of the COVID-19 pandemic to ensure CR programs return to pre-pandemic functioning and continue to deliver services in line with best practice and evidence-based recommendations.
KW - Cardiac rehabilitation
KW - COVID-19
KW - Health services research
KW - Secondary prevention
KW - Telehealth
UR - http://www.scopus.com/inward/record.url?scp=85146476515&partnerID=8YFLogxK
U2 - 10.1016/j.hlc.2022.12.008
DO - 10.1016/j.hlc.2022.12.008
M3 - Article
C2 - 36646580
AN - SCOPUS:85146476515
SN - 1443-9506
VL - 32
SP - 353
EP - 363
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
IS - 3
ER -