Creating a Hybrid Cardiac Rehabilitation Program

The Cardiac Rehabilitation Centre of the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal (CCO-CRC) operates an interdisciplinary program that serves patients from the Jewish General Hospital, the McGill University Health Centre and Saint Mary’s Hospital Centre. This centre was renovated and equipped by donors to the Azrieli Cardiac Centre Foundation and is funded on a recurring basis by the Ministère de la Santé et des Services sociaux (MSSS). It has been open at Richardson Hospital since September 2019. The cardiac rehabilitation program aims to support participating patients in the recovery of their cardiovascular event as well as to prevent future incidents.

When the pandemic arrived, about 6 months after the program opened, in-person services had to be stopped completely in order to comply with the measures put in place by the MSSS. Despite the implementation of a virtual follow-up with the participants, important gaps remained in the services they could receive.

CCO-CRC staff seized the opportunity to transform the service offering in innovative ways to fit the new sanity reality. The traditional, fully in-person program was transformed into a hybrid program that included both in-person supervised exercise sessions and virtual home-based services that included exercises and support provided by the various professionals.

The CCO-CRC hybrid program has three components:  

• Motivational interviews to gather patient concerns and needs;
• Group exercise and educational vignettes (in person and online);
• Virtual patient access to the entire interdisciplinary team, with in-person services as needed.

The program also offers live streaming of exercises and interactive educational vignettes, as well as recorded sessions available at any time. A “Partner Access” component was created on the institution’s website to meet this new need. To date, content continues to be added regularly for participants.

Within a few months, the CCO-CRC was able to increase its virtual services for all professional disciplines from 0% to 45%. On average, each participant receives 16 visits from kinesiologists and between 3 and 6 visits from other professionals, depending on their needs. The program also offers the option of participating entirely virtually for those who cannot travel to the site easily or for those who have fears or contraindications related to COVID-19. In addition, graduates of the program now have the option of continuing to participate in online group sessions to ensure maintenance of their new lifestyle habits.

The program continues to be a success! While the program saw approximately 120 patients participate in its first year, current data suggests that over 400 individual users will participate in the current year. Approximately 55% of users are now completing the hybrid program and clinical indicators confirm that the results obtained are equivalent to those of the in-person program. 

To top it all off, the program was recognized with an award from the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal’s Multidisciplinary Council (in a category related to telemedicine), as well as being featured in a webinar presentation and blog post by the U.S. based Advisory Board, one of North America’s leading health care consulting firms.

The Cardiac Rehabilitation Centre of the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal

The CCO-CRC, a branch of the Azrieli Cardiac Centre, takes an innovative patient-centered approach and is structured by integrated practice units. Services include physical activity, education and management of cardiovascular disease and its risk factors. Participants are supervised by kinesiologists during exercise sessions to learn about their limitations and abilities, thereby regaining confidence in performing their daily activities. Cardiac rehabilitation is considered one of the most “cost-effective” treatments in the field of cardiovascular medicine. A formal program like the one at the CCO-CRC reduces heart attack recurrence, re-interventions and even mortality by approximately 25%, all at a system cost of only $1,500 per patient.

The range of therapeutic activities offered to patients by the interdisciplinary team includes:

• The integration of regular physical activity into their lifestyle;
• a successful return to work;
• the adoption of healthy eating habits;
• smoking cessation;
• stress and anxiety management and;
• a better understanding of medication.