eCardiacRehab – a pragmatic trial on a home-based patient-centered e-Health programme with tailored solutions

In Norway, more than 11,000 patients with coronary artery disease undergo percutaneous coronary intervention (PCI) annually. However, a very recent study utilizing registry data show a national average of cardiac rehabilitation (CR) participation of only 14%, despite its proven beneficial effects on readmissions, physical capacity, psychological distress, self-management, and quality of life. CR is strongly recommended in European guidelines. However, uptake is low and is not systematically identifying those in most need of CR. The primary objective of eCardiacRehab is to meet rehabilitation needs of large patient populations regardless of their access to traditional place-based rehabilitation by developing and evaluating the efficacy and cost effectiveness of an interdisciplinary and comprehensive home-based eCardiacRehab programme. eCardiacRehab address patient- and system level challenges in order to increase access to CR. We give particular attention to older patients, women, and those with comorbidities or mental health challenges. Aspects related to continuity of care between specialist and primary care services, health literacy, adherence to treatment and lifestyle advice, cost effectiveness and ethics are investigated. We will 1) continue to develop the programme with patients, general practitioners, healthcare experts from both specialist and primary care services, and technology developers, 2) develop treatment modules, 3) establish information and communication infrastructure, 4) evaluate the process and efficacy of treatment modules, 5) ensure knowledge development and transfer of competence to the municipalities, and 6) contribute to fulfil the innovation potential for health service and industry partners. eCardiacRehab has the potential to improve interaction and collaboration between primary and secondary care, modernise and digitalise work processes, and develop more coherent and tailored patient pathways. The vision of the home-based eCardiacRehab is to make CR available to all. In December, a Kick-off was arranged at Haukeland University Hospital with both users and professionals in attendance. It was a broadly composed program with both the Assistant Director of Helse Bergen and the Assistant Medical Director of Helse Vest, users, and experts from different parts of the healthcare service. After extensive co-creation processes, the first version of the digital program eCardiacRehab has been developed. We are well on our way into the next phase to improve functionality and content. Several workshops have been organized with users during this phase. Collaboration with users, ICT, and a highly interdisciplinary group of experts from various parts of the healthcare service has been a major focus. Likewise, preparing for feasibility and inclusion of patients for the first trial run has also been emphasized. We have also placed great importance on extensive outreach through webinars, invited lectures and abstracts at conferences, as well as being part of a debate organized at Arendalsuka.

In Norway, more than 11,000 patients undergo percutaneous coronary intervention (PCI) annually. However, a very recent analysis of registry data show a national average of cardiac rehabilitation (CR) participation of 14% despite its proven beneficial effects on readmissions, physical capacity, psychological distress, self-management, and quality of life. CR is a Class 1A recommendation in European guidelines. However, uptake is low and is not systematically identifying those in most need of CR. The primary objective of eCardiacRehab is to meet rehabilitation needs of large patient populations regardless of their access to traditional place-based rehabilitation by developing and evaluating the efficacy and cost effectiveness of an interdisciplinary and comprehensive home-based eCardiacRehab programme. eCardiacRehab address patient- and system level challenges in order to increase access to CR. We give particular attention to the underserved; older patients, women, and those with comorbidities or mental health challenges. Aspects related to continuity of care between specialist and primary care services, health literacy, adherence to treatment, cost effectiveness and ethics are scrutinized. We will 1) continue co-creation with patients, GPs, healthcare experts from both specialist and primary care services, and technology developers, 2) develop treatment modules, 3) establish ICT infrastructure, 4) evaluate the process and efficacy of treatment modules, 5) ensure knowledge development and transfer of competence to the municipalities, and 6) contribute to fulfil the innovation potential for health service and industry partners. eCardiacRehab has the potential to improve interaction and collaboration between primary and secondary care, modernise and digitalise work processes, and develop more coherent and tailored patient pathways. The vision of the home-based eCardiacRehab is to make CR available to all.