Impact of SARS-CoV-2 pandemic in a phase II cardiac rehabilitation programme: looking back
Authors: Soria Navarro R , Tojal Sierra L , Juanes Dominguez I , Saez De Buruaga Corrales E , Virosta Gil E , Apodaca Arrizabalaga M J , Beltran De Guevara Sainz Pardo A , Gomez Corcuera E , Manzabal Gonzalez C , Fernandez Fernandez De Leceta Z , Para Barbero E , Pasalodos Heras M , Cortes Urruchi A , Alonso Gomez A M , Bello Mora M C 
Published: October 2021

Abstract

Introduction
SARS-CoV-2 has affected the whole world as a global health pandemic in 2020. A nationwide home confinement was declared in our country by beginning of March. Cardiac rehabilitation programs (CRP) had to adapt to new health requirements and the impact of these changes is unknown.

Purpose
To analyse the impact of COVID-19 pandemic in improvement of cardiopulmonary exercise test (CPET) with maximal oxygen consumption uptake (VO2max) and control of cardiovascular risk factors in patients with cardiovascular established disease (coronary heart disease, heart failure or cardiac surgery) included in the phase II of our centre CRP.

Methods
510 consecutive patients were evaluated. A maximal CPET was performed for each patient from the beginning and at the end of phase II of CRP. Enrolled patients were divided in two groups: from March 2019 to March 2020 (before Covid pandemic) and second one, from the beginning of the pandemic in March 2020 until February 2021.

Results
296 patients were studied in preCovid group and 214 patients were studied in Covid group. There were no statistically significant differences between these two groups in reference to cardiovascular risk factors and medical treatment (Figure 1).
82.7% of patients completed a hospital-based program in preCovid group vs 36% in Covid (p=0.001). Comparing the percentage of patients that accomplished the risk factors control targets between pre- and Covid group, statistically significant differences have been seen referring to systolic BP &lt;140mmHg (85.1 vs 95.4%, p=0.001) and cLDL &lt;70 mg/dl (67.2 vs 77.7%, p=0.003). However, in terms of glucose control (fasting blood glucose &lt;110 mg/dl: 78.4 vs 82.2%, p=0.612; HbA1c &lt;7%: 90.7 vs 92.7%, p=0.464) and weight control (BMI: 27.8±4.69 kg/m2 vs 27.3±4.07 kg/m2, p=0.299) this could not be established. There were no differences in psychological attention demand (27 vs 23.3%, p=0.695). Statistical differences between two groups were found in terms of VO2max at the beginning phase II CPET (22.7±7 vs 20±5 ml/min/kg, p=0.006) and ending phase II CPET (24±7 vs 21±6, p=0.001). Nevertheless, no differences were found in the final phase II CPET improvement between both groups (1.4±4.1 ml/kg/min vs 0.81±2.9 ml/kg/min; p=0.221) (Figure 2).

Conclusions
SARS-CoV-2 changed our practice from an in-hospital based phase II CRP to a home-based phase II CRP. COVID-19 pandemic had no negative impact in the control of risk factors in our phase II patients. In our experience, despite preCovid phase II patients have a better functional capacity in terms of VO2max, the improvement in VO2max after phase II CRP persists in the SARS-CoV-2 era. This might show that an accurate structure of home-based program could also have great results.

Funding Acknowledgement
Type of funding sources: None.