Telehealth use has risen dramatically as health systems look for ways to provide care while protecting providers and patients during the COVID-19 pandemic. In spite of the devastating effect of COVID-19, heart disease remains the number one death cause among adult men and women in the world. However, the big majority of patients do not follow the prescribed rehabilitation. The main reasons for this lack of compliance are simple motivation and limited access. Outpatient facilities are not always accessible, particularly for those in rural or island areas. Fortunately, virtual medical care – telehealth – directly addresses these issues. However, there is no service available in order to provide real time monitoring cardiac telerehabilitation. Our innovation consists of a specialized software that restores patients’ data and records real time vital signs. Our experienced department can monitor CR sessions in remote hospitals without specialized CR departments, with low cost.

Telerehabilitation is a branch of Telemedicine in which information and communication technologies are used to directly provide remote rehabilitation activities. So, we had the idea to develop tele-rehabilitation services for cardiac patients who cannot have easily access to our CR department. The CEO of our hospital, suggested to develop and apply tele-services to the cardiac patients of the islands of the the 2nd Regional Healthcare administration (RHA) of Piraeus and the Aegean Islands and in collaboration with other Public Hospitals that already have a Cardiac clinic but not Cardiac Rehabilitation section. In collaboration with the ‘asθenis’ (an experienced provider of digital solutions) we have designed and developed a sophisticated, adapted to our needs, software in order to provide supervised individualized exercise-based CR in real time to remote hospitals participating to the National Telemedicine Network.

• General Hospital Asklepieio Voulas (Hospital CEO, Cardiac Rehabilitation Section,
  Cardiology Clinic and Information Technology Department).
• The 2nd Regional Healthcare Administration (RHA) of Piraeus and the Aegean Islands.
• ‘Asθenis’, an experienced provider of digital solutions.

Citizens of remote areas will benefit by reducing the risks of death, hospital readmissions and by improving functional status, quality of life, mood, and medication adherence. This innovation will offer the opportunity to collect data that promotes scientific multidisciplinary research in cardiovascular diseases. Government will benefit by reduction of hospital readmissions and referral to urban centers and by improving healthcare services with low cost.

By the implementation of our innovation we expect that more cardiovascular patients will have access to CR programs which will improve their quality of life and reduce morbidity and mortality rates. Additionally, Tele-rehabilitation will help patients to have experience with their illness and with remote healthcare systems, fact that can promote the engagement to health activities and habits. Also, in this way the technology, can enable healthcare industry to move toward the multidisciplinary team-based care, which is crucial in Cardiac Rehabilitation.

Our long-term experience with Cardiac Rehabilitation services helped us to point out several barriers such as patient compliance. Thus, we managed to overcome them by the use of the appropriate, supervised, individualized CR programm. However, a lack of robust evaluation of this new delivery model, connectedness and other technological issues could become a barrier, which we are going to identify and manage during the pilot application we are about to start.

Our Hospital has the experience of Telemedicine, since it participates to the National Telemedicine Network (known as EDIT) which consists of 43 Telemedicine Units which interconnect Health Centers in the Aegean islands with Central Hospitals of the 2nd Regional Healthcare Administration (RHA) of Piraeus and the Aegean Islands. The Telemedicine Units are installed in 30 Health Centers on Aegean islands, in 12 Regional and Central Hospitals of the 2nd RHA and one in the operations center of the Ministry of Health.
Furthermore, our Cardiac Rehabilitation section is the only fully organized, well equipped CR center in Public National Health System of our country, providing high quality clinical and scientifical work in collaboration with Greek Universities and Cardiology Clinics.

This innovative pilot attempt can be used as a guide to further evolve hybrid models of Health Services in the future, in order to increase the access in specialized Health Centers with low cost strategies. More specifically, our CR section could use this technology to expand the provision of Telerehabilitation Services to patients with other pathologies such as neurological, respiratory patients. Furthermore, other Hospitals in Greece and other countries having similar obstacles could use this innovation to provide specialized health services to remote centers.

Working in Cardiac rehabilitation section of General Hospital Asklepieio Voulas, we have the opportunity to establish the health benefits of exercise-based rehabilitation in cardiac patients. Also, we have detected that main barriers to the participation in the CR are the access to our hospital and the lack of other specialized CR centers in our region. In Covid-19 pandemic our hospital treated only Covid-19 patients and our cardiac patients were isolated with no access to cardiac exercise-based rehabilitation. After the lockdown we confirmed that their general physical condition was deteriorated. Moreover, the number of our patients further increased with long-Covid patients who developed cardiac problems. Consequently, it was obvious that the abstention from exercise-based CR during pandemic had serious impact in their health.