Beatty, Alexis L.

Background Although telehealth cardiac rehabilitation (CR) may improve access, there are concerns about its long‐term effectiveness and impact on equity as compared with in‐person CR. Our objective was to tailor a patient‐centered telehealth CR program for diverse populations. Methods CR patients and caregivers were recruited between January and September 2023 from 4 US academic medical centers. Participants engaged in human‐centered design sessions to iteratively refine a telehealth CR program. Sessions had planned topics, but there was variation across sites to account for site‐specific needs and participant feedback. Sessions were qualitatively analyzed using rapid template analysis with preselected behavioral science constructs and other emergent codes. Results The study included 21 participants (71% aged ≥60 years, 48% women, 62% non‐Hispanic White individuals; 90% CR patients, 10% CR caregivers). Participants thought that telehealth CR could be helpful for personalized support at home and convenience but recognized that technology is not always easy to use. Some expressed concerns about the safety of telehealth CR, especially at the beginning, and desired monitoring through a mobile device or video observation of exercise. Safety protocols and technology training were developed, which addressed concerns about telehealth CR. Opportunities for social support with telehealth CR were also desired. From these findings, an implementation toolkit was developed, including a graphic program description, safety plan, home exercise plan for during and after CR, and scripts for technology training and individual and group telehealth visits. Conclusions A patient‐centered telehealth CR program and implementation toolkit were systematically tailored to address the needs of diverse populations.

Background: Delivering cardiac rehabilitation (CR) by telehealth may increase participation and promote equitable access to CR. Our objective was to tailor a patient-centered telehealth CR program to diverse populations. Methods: We recruited participants with varying CR experience (e.g. attended >1 session, did not attend CR, and caregivers) between January and September 2023 from four US academic medical centers. Participants engaged in human-centered design sessions on CR perspectives and a proposed telehealth CR program. Sessions were qualitatively analyzed using rapid template analysis with pre-selected behavioral science constructs and other emergent codes. Based on participant feedback, we iteratively revised the telehealth CR program and created an implementation toolkit. Results: Among 21 participants (76% ≥65 years, 50% female, 60% non-Hispanic White; 90% attended >1 session, 10% caregiver of a CR participant, 5% prefer not to answer), CR was overall regarded as valuable. Benefits included accountability, confidence, and feeling better. Social support was appreciated from family, friends, program co-participants, and CR staff. Participants emphasized the importance of early goal setting, accountability, and program individualization. Participants thought that using technology for telehealth CR could be helpful for accountability, facilitating relationships, and convenience. However, some participants had concerns about safety, especially at the start of their telehealth program, and desired checks such as a monitoring device or observation of exercise over video. Through human-centered design, safety protocols and technology training were developed, which participants thought addressed their concerns about participating in telehealth CR. The implementation toolkit informed by human-centered design included a participant journey, safety plan, home exercise plan for use during and after CR, and scripts for technology training and telehealth visits. Selected quotes are presented in Figure 1. Conclusions: We developed a patient-centered telehealth CR program and implementation toolkit. Future research will test the comparative effectiveness of in-person and telehealth CR on patient-centered outcomes.

Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.

Introduction Personal digital devices that provide health information, such as the Apple Watch, have developed an increasing array of cardiopulmonary tracking features which have received regulatory clearance and are directly marketed to consumers. Despite their widespread and increasing use, data about the impact of personal digital device use on patient-reported outcomes and healthcare utilisation are sparse. Among a population of patients with atrial fibrillation and/or atrial flutter undergoing cardioversion, our primary aim is to determine the impact of the heart rate measurement, irregular rhythm notification, and ECG features of the Apple Watch on quality of life and healthcare utilisation. Methods and analysis We are conducting a prospective, open-label multicentre pragmatic randomised clinical trial, leveraging a unique patient-centred health data sharing platform for enrolment and follow-up. A total of 150 patients undergoing cardioversion for atrial fibrillation or atrial flutter will be randomised 1:1 to receive the Apple Watch Series 6 or Withings Move at the time of cardioversion. The primary outcome is the difference in the Atrial Fibrillation Effect on QualiTy-of-life global score at 6 months postcardioversion. Secondary outcomes include inpatient and outpatient healthcare utilisation. Additional secondary outcomes include a comparison of the Apple Watch ECG and pulse oximeter features with gold-standard data obtained in routine clinical care settings. Ethics and dissemination The Institutional Review Boards at Yale University, Mayo Clinic, and Duke University Health System have approved the trial protocol. This trial will provide important data to policymakers, clinicians and patients about the impact of the heart rate, irregular rhythm notification, and ECG features of widely used personal digital devices on patient quality of life and healthcare utilisation. Findings will be disseminated to study participants, at professional society meetings and in peer-reviewed journals. Trial registration number NCT04468321