Remote Cardiac Rehabilitation Service Facilitates Patient Recovery
September 21, 2020 – COVID-19 is getting on our nerves, but the technology that entered our lives as a result of the pandemic is being used by doctors in other fields of medicine. One such area is the cardiac rehabilitation offered at Rambam Health Care Campus where a special app uses an elaborate fitness watch and a remote multidisciplinary team that accompanies individuals recovering at home following a heart attack. The COVID-19 pandemic and the accompanying periods of closure have changed lives and lifestyles on a multitude of levels. Even physical examinations by doctors are undergoing changes and being adapted to the new normal. At Rambam Health Care Campus, for example, advanced technologies are now being harnessed to assist patients while still practicing social distancing. This was the case for Nir Rosen, a 50-year-old married father of three who was recently rushed to the hospital suffering from a heart attack. He completed treatment in the hospital, but needed to undergo rehabilitation in order to fully recover. Given the limitations due to the virus and the need to maintain social distance, Rosen became one of the first patients at Rambam to undergo online cardiac rehabilitation. The unique program was personally tailored to his needs, and he is being guided by professional staff, all without requiring him to reach the hospital. Rosen, who lives in the Upper Galilee community of Mitzpe Adi and works in the logistics field, recently complained about pressure on his shoulder blades while trying to get into his car. "I felt a surge of heat and I was drenched in a cold sweat. I began to feel the pressure in my chest that moved towards my neck, and pressure that also increased around my shoulder blades." After evacuating to the local HMO branch, he was diagnosed as having a heart attack. Rosen was rushed to Rambam, where he underwent catheterization and the insertion of a stent to open an artery that was 90% blocked. Following the successful procedure, Rosen was told that he would need to undergo cardiac rehabilitation in order to recover, but was informed that he could do this at home under the remote guidance of the staff at Rambam. He was offered this innovative rehabilitation program because statistics show that more than 70% of those in need of rehabilitation after a cardiac event do not attend the rehabilitation programs offered by the hospitals at all. Dr. Oren Caspi, director of the Advanced Heart Failure Center in Rambam's Department of Cardiology, explains, "We have decided that completing one of the most effective treatments is not available to patients during the current COVID-19 pandemic. In fact, since the outbreak of the epidemic, we have been working in the Department of Cardiology to address the newfound need to make treatment accessible to patients at a time that suits them and in their natural environment, all under medical supervision." "Heart disease is the number one cause of death in the world, and it affects many patients. Unfortunately, it does not end in a single event. Patients who don’t pay attention to treatment, exercise, monitoring, and risk factors actually return to us in a worse condition," explains Dr. Boaz Elad, a cardiologist and head of Remote Cardiac Rehabilitation Service in the Department of Cardiology. "Prior to the COVID-19 pandemic, rehabilitation was carried out in a dedicated room in the hospital accompanied by a doctor and nurse. Now because of the virus, patients are less willing to come to the hospital, staff members are available less frequently, and there is a desire to reduce contact. This is where the virtual cardiac rehabilitation comes in." Remote Cardiac Rehabilitation - How Does It Work? Patients install a dedicated application on their mobile phone that includes a pedometer, reporting questionnaires, and personal messages. The database is personal and secure, and the training plan is formulated according to an initial stress test and subsequently by the patient's progress. Patients receive a smart heart rate monitor so they can train independently. At the same time, Rambam's multidisciplinary team closely monitors the patient's progress, and produces direct and online communication with patients via phone calls, videos, or encrypted text messages sent through the app. The smart app alerts when it detects abnormal results, reminds patients to return to training after they’ve taken unusually long breaks, and provides progress reports. The staff members give the patients personal feedback and, if necessary, remind them about appointments and other treatments. All data from the fitness training is also documented in the patient's medical file. "With the help of technology, it is possible to detect abnormalities in the patient’s data, encourage the patient remotely, and modify the structure of the personal rehabilitation program in order to help the patient continue rehabilitation," emphasizes Iris Eisen, nurse coordinator for the Remote Cardiac Rehabilitation Service. "In fact. the uniqueness of this program lies in the full cooperation required on the part of the patient, who must remain active in order for to properly recover." In the photos: Staff from Rambam’s Remote Heart Rehabilitation Service. Photography: Rambam Health Care Campus.
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