The Delivery of Cardiac Rehabilitation Using Communications Technologies: The "Virtual" Cardiac Rehabilitation Program.

Cardiac rehabilitation (CR) programs are a proven therapy for patients with cardiovascular disease, reducing future cardiac events and premature mortality. However, as little as 10% of eligible patients attend these programs, with a key reason being geographical inaccessibility. In Canada, more than 90% of Canadians have Internet access, and there are approximately 31 million cell phone subscribers, with these numbers expected to continue to increase. The proliferation of these affordable communications technologies has opened up opportunities for patient communication while bridging geographic distance. This has led to the development of "virtual" CR that can be remotely conducted, reaching patients in their homes and communities. These programs have used a range of technologies such as telephone, Internet, text messaging, and smartphones. Early research has focused on acceptance of use and feasibility in pilot studies, indicating patient willingness for use. More recently, a number of small, randomized trials have been conducted indicating potential positive effect on various clinical outcomes. This narrative review highlights the evidence to date on the use of virtual CR, using a variety of affordable communications technologies from early feasibility studies to modest randomized controlled trials. Finally, lessons from previous studies are discussed to help inform the development and testing of future virtual CR. This will be important if virtual CR is to become part of standard health care.