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Reducing secondary cardiac events with virtual cardiac rehab

Kaiser Permanente has demonstrated promising results in reducing secondary cardiac events and rehospitalizations by creating a virtual cardiac rehabilitation program that fits seamlessly into patients' lives. Increasing rates of program enrollment and completion have been key factors in the improved outcomes. Results and details about the program were published today in NEJM Catalyst.Cardiovascular disease is the leading cause of death in the United States . While cardiac rehabilitation programs -- prescribed exercise and diet, as well as health education and counseling -- can significantly reduce the risks related to cardiovascular disease, few cardiac patients enroll in rehabilitation programs, and even fewer complete them .
Kaiser Permanente's virtual cardiac rehabilitation program, developed in collaboration with Samsung, combines wearable technology with support from an assigned health care team. The program has enrolled more than 2,300 patients, making Kaiser Permanente's virtual cardiac rehabilitation program one of the largest in the U.S. More than 80% of the patients who have joined the program complete it, compared to the national average of less than 50%. Cardiac-related hospital readmissions for patients in Kaiser Permanente's program have been less than 2%, compared to 10-15% average for most programs .

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"Knowing that lifestyle change plays such a critical role in the long-term health of cardiac patients, we set out to find a way to make the rehabilitation program as easy and seamless as possible for our members," said Tad Funahashi, MD, who leads clinical innovation at Kaiser Permanente in Southern California. "By working closely with patients, care providers, and case managers we were able to do just that. Our virtual cardiac rehabilitation program is proving to keep patients engaged and reduce readmissions."
The Kaiser Permanente program has graduated 1,880 patients since 2018. Clinicians anticipate serving the needs of more than 5,000 patients in 2019. "Weekly contact with the nurse provided tremendous reassurance for me," said Michelle Wofford, 42, a Kaiser Permanente member who enrolled in the program after she had a stent placed to open a blockage in a coronary artery. "In addition to using the watch and smartphone app to stay on track with my physical activity, I also had access to a nutrition class. The Plants for Life class was life-changing and emotional for me because I realized that I needed to change my diet to avoid going down a path I could not come back from."

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About the Virtual Cardiac Rehabilitation Program Patients are encouraged to enroll in the eight-week virtual cardiac rehabilitation program. Once enrolled, patients meet with their care team to create a rehabilitation program specific to their unique needs. They use a Samsung smartwatch that pairs via Bluetooth with an Apple or Android smartphone. The watch sends reminders to the patient to exercise, collects patient activity data and continuously displays the patient heart rate during exercise. This data is automatically uploaded via the smartphone into the patient's chart so that clinicians, case managers and physical therapists can track patient progress and engage with them accordingly.

Using the smartphone and Kaiser Permanente's existing digital platform, patients meet virtually with a care manager once a week to discuss their progress and learn about lifestyle modification as it relates to their own unique needs. They can also contact a care manager for an immediate response to concerns about symptoms or medications. After graduation from the program, wellness coaching is offered for an additional eight to 12 weeks to assist members in their journey toward lifestyle change.

"The clinical benefits of regular meetings with and 24/7 access to the care team are two-fold: Care providers foster stronger relationships with patients due to additional touch-points, and patients receive a more holistic treatment plan with wraparound services such as wellness coaching and counseling," said Columbus Batiste, MD, chief of cardiology at Kaiser Permanente Riverside Medical Center. "However, for many patients, the most rewarding aspect of virtual cardiac rehab was having ownership over their health. By tracking progress, patients became invested in their care."

Although virtual reality can be used for gaming, it is also becoming popular for other purposes such as allowing a person to feel as if they are in a virtual reality documentary.

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