Understanding cardiac rehabilitation delivery in Scotland during the COVID-19 pandemic: lessons for the future

Cardiac rehabilitation services were disrupted during the early stages of the COVID-19 pandemic because of limitations on interpersonal contact, exercise facility closures and clinical service reorganisation. This necessitated urgent service redesign. The authors aimed to understand the changes to cardiac rehabilitation service delivery in Scotland, the impacts on staff and participant experiences, and implications for future delivery. A concurrent mixed-methods study was conducted between April and December 2021. A quantitative online survey compared service provision before the pandemic (21 March 2019 to 20 November 2019) with provision after the onset of the pandemic (21 March 2020–20 November 2020). Quantitative data were analysed descriptively. Semi-structured telephone interviews were conducted with cardiac rehabilitation professionals and participants. These qualitative data were thematically analysed using the framework approach. Representatives (n=11) from 11 services completed the survey, while 11 staff and 17 patients completed the interviews. Services reported staffing reductions, delayed initial patient contact, replacement of face-to-face rehabilitation with telephone and online support, compromised initial assessments and reduced exit assessments. Patients relied more heavily on cardiac rehabilitation staff as a result of reduced access to other health professionals, and experienced issues with continuity of care. Technology presented remote service opportunities, but challenges around poor access to systems and technological literacy issues created barriers to service delivery. Service evaluation data were inaccessible. Scottish cardiac rehabilitation services were adversely impacted by the COVID-19 pandemic and responded by developing remote options. These can be enhanced by screening patients to assess their access to technology and identify any literacy issues, as well as developing online educational videos and downloadable resources. Staff education is needed to encourage use of technology, including exercise monitoring via wearables. A national audit is required to assess delivery and outcomes.