Consensus Statement on the Virtual and Remote Delivery of Cardiac and Pulmonary Rehabilitation and Their Components

The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) convened a writing group to define virtual and remote delivery of cardiac and pulmonary rehabilitation (CR-PR) services and their components. Virtual CR-PR is delivered using synchronous real-time audiovisual communication, while remotely delivered CR-PR is delivered asynchronously. In many cases, a hybrid of these approaches may be optimal, including a mix of in-person, virtually, and remotely delivered sessions. Regardless of the delivery method, CR-PR must include all core components listed in the most recent scientific statements and relevant guidelines from AACVPR. The metrics to assess the performance and quality of CR-PR remain the same, irrespective of the delivery methods. CR-PR programs should consistently track patient outcomes and care quality, which can be standardized by the use of the AACVPR registries (https://www.aacvpr.org/Registries) to monitor program and patient outcomes. Patient selection is critical to optimizing and utilizing appropriate CR-PR resources to ensure the CR-PR model fits the patient's medical status and preferences. A comprehensive assessment, preferably in-person, if possible, should precede program initiation. The exercise prescription used for virtual/remote CR-PR models should not differ from in-person CR-PR but should be adapted to the patient's environment, needs, and existing resources. Emergency and safety protocols, and education of the patient and caregivers regarding such protocols, should be established for virtual/remote CR-PR programs. In-person delivery of CR-PR is the most evidence-based model for delivering the service and remains the consensus recommendation for all eligible patients willing to attend; however, alternative models of CR-PR (virtual, remote, and hybrid) can be implemented to increase the number of patients benefiting from CR-PR programs.