Help with rehab after a heart attack
TRADITIONALLY AFTER A PATIENT suffers a heart attack, their physician would encourage them to enroll in a multiweek on-site cardiac rehab program. There the patient receives health counseling, as well as prescribed exercise and diet that decrease the likelihood of a secondary cardiac event. The patient would visit a facility for medically supervised exercises.
Enrollment in such programs tends to be “quite low,” in part because it’s inconvenient, said Dr. Tad Funahashi, an orthopedic surgeon and chief innovations and transformation officer at Kaiser Permanente in Southern California.
So, about three years ago, the Oakland, Calif.-based health system and health insurer began trying an eightweek virtual program for patients stable enough to complete the program at home.
It’s since been scaled across medical centers in Southern California and Georgia, and Kaiser is working to expand it across its seven regions. Participants wear a Samsung smartwatch to monitor activity levels and heart rate while completing prescribed exercises; they also answer questions through an app about exercise patterns, symptoms and medication adherence. The data is shared with Kaiser’s electronic health record system to populate a dashboard that care teams review to inform adjustments to their treatment plan.
Patients also complete weekly check-ins via phone call or video visit with care managers.
More than 80% of patients who enrolled in Kaiser’s virtual program complete it, compared with less than 50% on average for the system’s in-clinic cardiac rehab program. Less than 2% of patients who enrolled in Kaiser’s virtual cardiac rehab program experienced a cardiac-related hospital readmission, according to findings published in NEJM Catalyst last year.
Kaiser provides the smartwatches to patients for free, and they’re returned when the program ends. Kaiser has a contract with Samsung for the smartwatches. They aren’t purchased off the shelf, Funahashi said, since they’re outfitted with software specifically developed to link with Kaiser’s systems.
Funahashi declined to share financial details of the contract. He said running the virtual program is more cost-effective than traditional in-person cardiac rehab at a facility.
Kaiser expects 4,000 to 5,000 Southern California patients to go through the virtual program annually, Funahashi said. Kaiser continues to tweak the program, such as looking into whether using a wearable device with a longer battery life could improve outcomes by also monitoring patients’ sleep patterns.