Assessment of on-site and remote cardiac rehabilitation in Romania
Authors: Ciuca-Pana M , Serbanoiu L , Cojocaru V , Olteanu G , Andronic O , Lacraru A , Ion A , Andrei C , Sinescu C , Suceveanu C M , Mandu M , Onose G , Pedretti R , Niebauer J , Busnatu S 
Published: June 2024

Abstract

Introduction
It is well known that cardiovascular diseases are the leading cause of death worldwide. In Romania in 2015, cardiovascular diseases led to 153.953 deaths, representing 59.3% of deaths from all causes. Most people in Romania today have an unhealthy lifestyle, characterised mainly by a poor nutritious diet, low physical activity and a lack of medical screening.

Purpose
Considering these deficits of secondary prevention in the treatment line of the Romanian cardiovascular patient, we aimed through this study to assess the current access of the Romanian population to on-site and remote cardiac rehabilitation programs as well as their opinion regarding the telemedicine for future cardiovascular care modelling.

Methods
It was a prospective observational study, which was carried out by means of an online questionnaire composed of 26 items. It was dispersed in the online environment, including Social Media platforms, where it was active for ten weeks. The 26 items that formed the survey led to obtaining social, demographic and medical information, to evaluating the level of technology used at home, knowledge related to cardiac rehabilitation programs and the interaction with telecare services. Impediments associated with the impossibility of participating in classic cardiac recovery programs were also evaluated.

Results
Our online evaluation questionnaire had 1115 participants, with a minimum age of 18 years old, a preponderance of female sex and a predominantly urban background. The study participants were from all educational levels, from low to superior. We observed that most participants have an internet connection at home and use at least one form of technology daily, but most have never used a telemedicine service. Less than 50% of participants had a history of cardiovascular disease the most common of which was heart failure. However, more than 50% of people knew the indications for a cardiac rehabilitation program. Of the patients in need of such a program, only 75 received a discharge recommendation; out of these, only 24 patients were referred to a specialised centre. Most participants were unaware of a cardiac rehabilitation center or the components of a cardiac recovery program. Participants who completed a cardiac rehabilitation program had a medium to long waiting period prior to enrolment; some did not perform it for an adequate period of time.

Conclusions
In conclusion, the access of cardiovascular patients to on-site cardiac rehabilitation services is extremely low and for remote ones, it is almost non-existent. Internet access is neither a problem for the Romanian population nor technological knowledge, so the optimal solution for secondary prevention of cardiovascular disease is represented by cost coverage of remote cardiac services by public insurance through the National Health Insurance House. Romanian counties of study participants Questionnaire structure