The impact of the COVID-19 pandemic on the quality of centre-based cardiac rehabilitation

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency Ministry of Health, Slovenia. Background The coronavirus-19 (COVID-19) pandemic has severely disrupted the provision of cardiac rehabilitation (CR), with responses ranging from outright closure of CR centres to adapting CR provision to the diversion of resources and changing public health guidance. Using interrupted time-series analysis, we sough to estimate the impact of the COVID-19 pandemic the quality centre-based CR. Methods Quality indicators for 1,268 patients undergoing centre-based CR after a myocardial infarction were extracted from the national CR registry, and summarized with a composite quality score (i.e., adjudicating one point for each: antithormbotic therapy, high-potency statin therapy, low-density lipoprotein cholesterol [LDL-C] <1.4 mmol/L, systolic blood pressure <130 mmHg, body mass index <25 kg/m2, non-smoking status, >20% improvement in exercise capacity from baseline). Composite quality scores were aggregated on monthly time units; an interrupted time series of 52 time points was constructed, with breakpoint defined on 1 March 2020. Using Prais-Winsten (autoregressiove order 1) segmented regression, change in level and time trend of the composite quality score were estimated, with 95% confidence intervals [95%CI]. Results After the pandemic outbreak, waiting times for CR increased (from 56 [IQR 36-82] to 75 [IQR 58-102] days, p<0.001), while duration of CR (from 100 [SD 58] to 90 [SD 67] days) and number of sessions (from 33 [SD 7] to 28 [SD 9]) decreased (p<0.001 for both). The outbreak of COVID-19 was associated with a non-significant change in level (+0.370 [95%CI -0.207; 0.946] points, p=0.204) and a significant change in trend (-0.0438 [95%CI -0.0841; -0.0437] points/per month, p=0.034) of the composite quality score. Patterns for estimates did not change significantly after adjustment for number of sessions and/or duration of CR. See Figure 1. Conclusons The COVID-19 pandemic has affected the quality of centre-based CR, with a trainsient (non-significant) increase followed by a persistent (significant) trend of decreasing quality of CR provision. Our findings suggest the need for intensifying the quality of secondary prevetive care during CR in the forthcoming post-pandemic recovery.