Katrina Wilson, Principal Advisor at Eastern AHSN explores how the rapid adaptation of an ongoing pilot in remote cardiac rehabilitation supported self-care and patient empowerment during the COVID-19 pandemic, as well as her tips on navigating similar situations in the future.

The NHS Long Term Plan describes a future where patients, through the use of digital services in particular, will be empowered to participate more in self-care and self-management to improve their health care experience and outcomes, reduce pressure on the NHS and provide better value for money.

One such area is remote cardiac rehabilitation, which typically involves a mix of face-to-face exercise and education group classes. Regular exercise is one of the best ways for people to make a good recovery following cardiac surgery or a heart attack, however in England only 50% of eligible patients take up the service.1 An additional challenge is ensuring that those patients who do engage continue with healthy habits into the future.

Home-based monitoring

To explore if this would impact long-term adherence in cardiac rehabilitation services, Addenbrooke’s Hospital, supported by Eastern AHSN, initiated a pilot in September 2019 using the digital programme Active+me, designed and delivered by Aseptika Ltd.

Patients on the Active+me pilot were provided with standard cardiac rehabilitation care, reinforced by educational resources and medical monitors to take home and record progress such as activity levels, blood pressure, weight and oxygen saturation, as well as peer-to-peer support groups.

Cambridgeshire-based Steve King enrolled onto the pilot in January 2020 after having a triple heart bypass in September 2019. He reflected:

“I had a heart attack in December 2014, which should have been a big wake-up call but my heart attack was minor and looking back on it now I didn’t recognise I was particularly ill. So, I completed my cardiac rehabilitation and went back to work, without keeping up the exercise programme or making the changes I probably should have made to my diet and lifestyle. Subsequently I found myself needing a triple heart bypass five years later.”

“After my surgery I started my cardiac rehabilitation and enrolled onto the Active+me pilot. I also found out that I was borderline type 2 diabetic, which was further motivation to make a lifestyle change. Now I measure my weight, blood pressure and blood oxygen levels – all of which I didn’t pay any attention to before – as part of my daily routine.”

The data Steve collects is shared securely with Addenbrooke’s Hospital using a secure cloud, to monitor his progress and address any concerns.

For example, Steve received a call from Anna Sydes, Cardiac Rehabilitation Exercise Physiologist at Addenbrooke’s Hospital as she had noticed Steve’s blood pressure had been rising over several days. Steve recalled:

“On Anna’s advice I spoke to my GP and using the data from Active+me I was able to explain my change in blood pressure and the GP agreed to adjust my medication accordingly. It felt very reassuring that Anna and the team were looking out for me and it was empowering to have the data at hand to have an informed conversation.”

Cardiac rehabilitation during COVID-19

The Active+me pilot at Addenbrooke’s Hospital was well underway and then the COVID-19 pandemic paused all face-to-face cardiac rehabilitation appointments. So Addenbrooke’s Hospital, Eastern AHSN and Aseptika (who received support through the Innovate UK COVID-19 business-led innovation in response to global disruption funding), worked together to rapidly adapt the Active+me platform and ensure the same high-quality level of cardiac rehabilitation could be delivered remotely to Cambridgeshire patients from beginning to end without any face-to-face contact.

This approach can also empower patients to take charge of their recovery, with the added reassurance of the cardiac rehabilitation team remotely monitoring progress, identifying any concerns and supporting early intervention where necessary in the initial stages.

Steve’s cardiac rehabilitation was still ongoing at this point and he reflected:

“After the experience with my blood pressure rising I decided I would commit to the group fitness classes in the next phase of my rehabilitation, but there was a waiting list for spaces. However, when COVID-19 caused all the fitness classes to be moved onto Zoom the classes could accommodate more people, so I was able to join straightaway. That was a real benefit as I wanted to join the sessions while I was still motivated.”

“I am really grateful I took part in the pilot, I feel much more self-aware, confident and in control of what I do now.”

Adapting a pilot at pace

Implementing a pilot during the pandemic has been a challenge but we are pleased with how quickly all partners came together to adapt and deliver the pilot, which has resulted in a new service called Active+me REMOTE Cardiac Recovery which will be delivered remotely in partnership with cardiac rehabilitation centres. The programme was also accepted onto the Advanced Wellbeing Research Centre’s Wellbeing Accelerator at Sheffield Hallam University, through which the project gained access to the Sport and Physical Activity Research Group who are undertaking an independent evaluation.

Here is our advice to others working at pace to implement a pilot:

  • Make a plan – no matter how quickly a pilot needs to be implemented, nothing beats creating a plan with clear timelines, roles and responsibilities, especially during a pandemic.
  • Be flexible – a plan is important, but equally important when the landscape around you is moving at pace is to be open to change. For example, you may also want to consider planning a contingency budget to accommodate unexpected costs.
  • Maintain a solution-based mindset – with change will inevitably come challenges that need to be overcome. Don’t be afraid to suggest solutions, even if they’ve been suggested before – a rapidly evolving landscape may mean it can be reconsidered.
  • Factor in evaluation from the start – consider who is best placed to conduct the evaluation and involve them as soon as possible to ensure the pilot is set up to collect the right data.
  • Focus on the patient – don’t lose sight of the patient and patient outcomes. Remember that any reservations patients have will impact recruitment onto the pilot. Consider how you can make them feel more at ease – asking directly often produces the best insights.

References

1 – British Heart Foundation, (2019). The National Audit of Cardiac Rehabilitation: quality and outcomes report 2019 [online]. British Heart Foundation. [Viewed 20th July 2020]. Available from: https://www.bhf.org.uk/informationsupport/publications/statistics/national-audit-of-cardiac-rehabilitation-quality-and-outcomes-report-2019