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Updated: Jun 18, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Co-designing a cardiac rehabilitation program with knowledge users for patients with cardiovascular disease from a
Jessica Bernier1, Mylaine Breton2,3, Marie-Eve Poitras4,5
1Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Saguenay-Lac-St-Jean, 305, Saint-Vallier, Chicoutimi, Québec, G7H 5H6, Canada.
Insights
A new cardiac rehabilitation program was designed for remote areas, improving cardiovascular disease care equity. This user-centered approach adapted services to overcome staffing shortages and enhance patient access in underserved regions.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Cardiovascular disease is a leading global cause of mortality.
- Cardiac rehabilitation (CR) programs are effective but inequitably distributed.
- Remote areas have limited access to CR services (<15%).
Purpose of the Study:
- To design a cardiac rehabilitation (CR) program tailored for remote regions.
- To improve the accessibility and equity of CR services for patients in underserved areas.
Main Methods:
- Iterative user-centered design approach with co-design processes.
- Two advisory committees (managers, healthcare professionals, patients) in two remote regions.
- Utilized BACPR guidelines and a health authority operational model for program development.
Main Results:
- Developed a prototype CR program with a six-phase pathway adapted for remote settings.
- Structural changes in care phases (0, 2, 3, 4) addressed staffing shortages and decentralized expertise.
- Integrated therapeutic patient education and proposed nursing-led follow-ups to increase access.
Conclusions:
- Co-design effectively met the specific needs of remote regions for CR program development.
- The developed program is suitable for future implementation research to enhance cardiovascular care delivery.
Background:
Cardiovascular disease is the leading cause of death worldwide. Cardiac rehabilitation (CR) programs are recognized as effective in reducing the burden of cardiovascular disease. However, CR programs are offered inequitably across regions and are available in less than 15% of remote areas worldwide. The main goal of this study was to design a CR program adapted to the contexts of remote areas to improve the service offered to patients.
Methods:
We used an iterative user-centered design approach to understand the user context and services offered in cardiac rehabilitation in remote areas. We conducted two co-design processes with knowledge users in two remote regions. Two advisory committees were created in each of these regions, comprising managers (n = 6), healthcare professionals (n = 12) and patients (n = 2). We utilized the BACPR guidelines and the Hautes Autorités de santé operational model to support data collection in coding sessions to develop the CR program. We conducted four cycles of co-design with each of the committees to develop the cardiac rehabilitation program. Qualitative data were analyzed iteratively after each cycle.
Results:
The co-design process resulted in developing a prototype cardiac rehabilitation program similar in both regions. It is based on a contextualized six-phase pathway of care designed for remote regions. For each phase 0 to 6 of the care pathway, knowledge users were asked to describe how to offer these phases in remote areas. Participants made structural changes to phases 0, 2, 3 and 4 in order to overcome staffing shortages in remote areas. These changes make it possible to decentralize cardiac rehabilitation expertise away from specialized centers, to ensure equity of service across the territory. Therapeutic patient education was integrated into phase 4 to meet patients' needs. Participants suggested that three follow-up offerings could come from nursing services to increase access to the cardiac rehabilitation program (primary care, home care, special chronic disease programs) in patients' home communities.
Conclusion:
The co-design process enables us to meet the needs of remote regions in program development. This final program can be the subject of future implementation research.
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