How the COVID pandemic affected utilisation of cardiac rehabilitation in rural Australia?

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Caring Futures Institute Background Provision of cardiac rehabilitation (CR) was disrupted in 31% of the 155 countries according to the World Health Organisation during the early months of the COVID pandemic. This might have been associated with worsening clinical outcomes and is of particular concern to patients living in rural and remote areas. In Australia, these patients have a higher prevalence of cardiovascular diseases, higher rates of adverse outcomes due to acute myocardial infarction and limited availability to regional services. Purpose We aimed to investigate how the COVID affected the delivery of CR services in rural and remote South Australia (SA) during the first wave of the COVID pandemic.  Methods CR attendance, completion and waiting times in the pre-COVID period (February-July 2019) was compared to data during the first wave of COVID (February-July 2020) using data from CR services across six regional local health networks recorded in the Country Access to Cardiac Health (CATCH) database. Results There were 922 patients (32.2% females; mean age 69.2 years; 36.6% living in areas with high socio-economic disadvantage) referred to CR in the pre-COVID period, and 1032 patients (30.7% females; mean age 68.1 years; 35.7% living in areas with high socio-economic disadvantage) in the COVID period across the six regional areas in South Australia. Acute coronary syndrome was the main reason for referral both pre (251; 27.2%) and during COVID (273; 26.5%). The proportion of CR attendance was higher in the pre (522; 56.6%) compared to the COVID period (431, 41.8%; p < 0.001).  Completion was higher pre (413, 79.1%) compared to during COVID period (205,47.6%) completed CR during the COVID period (p < 0.001). The waiting time was 35 (SD 27) days pre-COVID and 34 (SD 25) days in the COVID period (p = 0.37). Conclusion Our data show that attendance and completion of CR programs were significantly reduced during the COVID period in rural and remote Australia. Limited service access during the pandemic and fear to physically attend health services during the period of social and physical restrictions might have contributed to this. Telehealth-delivered CR can provide opportunities to continuity of cardiovascular care and secondary prevention during pandemic restrictions.