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Cardiac Telerehabilitation

The General Hospital Asklepieio Voulas has developed an exercise-based cardiac telerehabilitation program in order to increase the participation of eligible patients in cardiac rehabilitation services. Through this, Government and cardiovascular patients will benefit since participation in a CR program can reduce the risks of death and hospital readmissions. To our knowledge this is the first attempt to develop a telerehabilitation program offering a structured, real time, supervised exercise.

Innovation Summary

Innovation Overview

Cardiovascular diseases (CVDs) are the leading cause of death globally. Additionally, studies have shown that Covid -19 can further increase a person’s cardiovascular risk. Exercise-based Cardiac Rehabilitation (CR) is a comprehensive secondary prevention program designed to improve cardiovascular health following a cardiac event or procedure. An optimal Cardiac Rehabilitation experience consists of 36 one-hour sessions that include team-based supervised exercise training, education and skills development for heart-healthy living, and counseling on stress and other psychosocial factors (Mayo Clinic Proceedings, 2016). Participation in a CR program can reduce the risks of death from any cause and from cardiac causes, as well as, decrease hospital readmissions. CR participation also improves functional status, quality of life, mood, and medication adherence.

Despite these benefits, participation in CR remains low, due to the lack of specialized centers. Apart from low economic funding of National Health System due to recession, one of the factors that increase the inequality in access to health services is the geographical specificity of our country which includes many islands. Residents of remote areas, small and isolated islands have problems accessing specialist doctors and specialized laboratory centers. Citizens, especially those with health problems, are forced to move to urban centers where appropriate services are available.

Taking into account all the above, the General Hospital ‘Asklepieio Voulas’ in Greece, in association with the 2nd Regional Healthcare Administration (RHA) of Piraeus and the Aegean Islands has developed an exercise-based Cardiac Telerehabilitation program in order to increase the enrolment and the participation of eligible patients to cardiac rehabilitation services.
At General Hospital Asklepieio Voulas, the Physical Therapy department in collaboration with the Cardiology clinic, has established a Cardiac Rehabilitation section that offers, after thorough medical and physical assessment, a structured, supervised, individualized exercise program to cardiac patients. Through this innovation, the specialized healthcare professionals of Cardiac Rehabilitation section will be able to offer high quality specialized CR services to residents of remote areas.

The objectives of this innovation are to:

  • Increase the enrollment and participation in CR services.
  • Improve the cardiovascular disease management and reduce cardiovascular risk.
  • Reduce hospital readmissions and referral to urban centers.
  • Meet the growing needs of the population adopting cost effective national strategies.

This innovative pilot attempt can be used as guide to further evolve hybrid models of health services in the future, in order to increase the access in specialized health centers with cost effective strategies. Additionally, this innovation will offer the opportunity to collect data and extract relevant information that promotes scientific multidisciplinary research in cardiovascular diseases.
Telerehabilitation is a branch of telemedicine in which information and communication technologies are used to directly provide remote rehabilitation activities.

Provision of Cardiac Rehabilitation has been directly impacted by coronavirus disease and the measures implemented, highlighting the need to develop telerehabilitation and telemedicine services in order to allow continuity of care for patients who can benefit from remote consultations, while ensuring greater protection for those who are members of vulnerable groups. Thus, we were inspired to develop a sophisticated, well-structured Cardiac Telerehabilitation program aiming to offer in real time the specialized service of our hospital in more remote centers with low cost.

Innovation Description

What Makes Your Project Innovative?

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.

What is the current status of your innovation?

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.

Innovation Development

Collaborations & Partnerships

  • 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.

Users, Stakeholders & Beneficiaries

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.

Innovation Reflections

Results, Outcomes & Impacts

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.

Challenges and Failures

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.

Conditions for Success

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.

Lessons Learned

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.

Year: 2022
Level of Government: National/Federal government


  • Developing Proposals - turning ideas into business cases that can be assessed and acted on

Innovation provided by:

Date Published:

2 January 2023

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