Digital innovation in cardiac rehabilitation 'essential' to boost attendance rates

Cardiac rehab must be offered digitally if services are to meet the 85% ambition set by NHS England, experts say.

22 March 2019, by Siobhan Chan

Cardiac rehabilitation innovation event, held in St Bartholomew's Hospital

Cardiac rehabilitation services must embrace novel technologies to hit ambitious new attendance targets, according to health leaders.

Web- and app-based programmes are among the ‘radical’ options that must be explored if the NHS is to recruit significantly more patients over the next decade, they said. Healthcare professionals must also be supported to work with these technologies.

Cardiac rehab specialists, academics and industry leaders joined an event in the capital hosted by the BHF, the London Cardiac Clinical Network, the Health Innovation Network and DigitalHealth.London on 11 February 2019.

Kelly Read, Clinical Development Coordinator at the BHF and one of the event organisers, said: “We need to do more so that eligible patients take up the offer of cardiac rehab. The NHS Long Term Plan talks about the need to increase uptake in cardiac rehab, and the National Audit of Cardiac Rehabilitation (NACR) report proposes digital innovation as a way of doing this.”

In January, NHS England’s Long Term Plan set an ambition to achieve an 85% uptake rate for cardiac rehab over the next decade. Currently, just over half of eligible patients attend.

Professor Patrick Doherty, Director of the NACR, said: “In the last 7-8 years we’ve increased uptake by 3-4%. That’s just not good enough – moving to 85% is just not achievable in my lifetime if we continue this way. We have to be radical.”

Digital options

According to the 2018 NACR report, around 80% of patients attend group-based rehab and few attend web-based programmes.

“The population[s] we presently serve are not the populations that benefit most. We need to recruit from the older, multi-morbid and ethnic minority communities,” Professor Doherty said.

“Many programmes would benefit from digital innovation, as patients [could start] earlier,” he added. “Wait time matters – the longer patients wait, the poorer the outcome. Digital solutions could also free up time for services to focus on the multi-morbid population.”

Apps considered

Current web-based cardiac rehab programmes provide education, self-monitoring , and allow patients to share records with their healthcare professional.

Healthcare professionals could be surprised at which patients were most interested in digital solutions, according to Dr Carolyn Deighan from NHS Lothian, who developed the web-based programme The Digital Heart Manual.

She said: “We thought younger people wanted a digital resource, but we had people in their 70s and 80s wanting to use it, and people in their 30s saying they didn’t want to look at a screen.”

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Apps with a self-monitoring function could highlight changes in health that would otherwise go unnoticed, according to Natalie Oates from digital tech provider Inhealthcare. For instance, weight gain in someone with heart failure might indicate fluid retention.

Menu-based rehab

Clare Thomson, Senior Project Manager at NHS England Cardiac Clinical Network, said that the London Cardiac Clinical Network was looking at ways of increasing the menu of rehab options.

Technology should be used “as an adjunct to therapy”, she said, and commissioners and NHS managers should work with frontline healthcare professionals to decide which web-based programmes patients are offered.

Sally Hinton, Executive Director of the British Association for Cardiovascular Prevention and Rehabilitation (BACPR), said that digital opportunities for rehab delivery would be a focus for the association in the coming years.

“Cardiac rehab services have to ask themselves: ‘Are we truly menu-based – do we truly offer a digital option?’” she said. “We have to change in order to improve uptake rates in the next 10 years, while still working towards patients’ agreed individual goals.”



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