How cardiac rehab gets to the heart of the matter

KITE scientist Dr. Tracey Colella is determined to increase the reach and effectiveness of cardiac rehabilitation

Like the lyrics of an angst-filled ballad, our hearts don’t get enough attention in Canada, especially when it comes to recovery from a serious heart-related event. Some scientists and doctors are pushing for great change in that area, and one of its strongest advocates is KITE Research Institute scientist Dr. Tracey Colella.

Dr. Colella didn’t always know she wanted to work in the realm of cardiac rehabilitation (CR), but she did know, at least as early as high school, that she wanted to be in healthcare. Her reason for focusing on the heart was personal. 

“I ended up getting into cardiovascular surgery and cardiology because my grandfather had a heart condition,” she says. However, it was her time working at Sunnybrook Health Sciences Centre as a nurse practitioner that most profoundly influenced her career path. 

“I ended up doing research on patient-oriented questions; patients were being discharged home within five days after having major open-heart surgery and feeling they were a bit lost to the system.” 

She noticed a pattern with the experiences of post-op patients and decided to do something about it.

“My colleague and I started a callback program because we had many callbacks from patients asking questions about recovery and some of the symptoms they were experiencing. Many of these questions could best be answered by other people who had been through this surgery; there's a history of research examining this idea of peer support,” she says. “That's when I really became interested in the role of peer support in a patient's recovery.” 

Dr. Colella believes that one of the pillars of CR (and any kind of recovery for that matter) is peer support, which is informational and emotional support to the recovering person from someone who has already lived through the experience of recovery – in this case, CR. It is the emotional component particularly that she feels is fundamental to recovery. 

“Someone like myself, a clinician, or friends and family who haven't lived through this procedure or experience cannot truly understand every aspect of recovery. I can provide medical or clinical support for several issues, but when it comes to understanding the personal experience of symptoms and the emotional challenges, it's someone who's been through this who can really help solidify that recovery and see people through to feeling better both mentally and physically.” 

One of the great by-products of peer support is that it often inspires the person who received the support to then become someone who offers it. 

“These individuals often want to give back because someone helped them through a challenging time; this support can be cyclical and it's really inspiring.”

One of the main obstacles with the effectiveness of CR is the immense lack of awareness. Dr. Colella finds it frustrating that there are still some medical professionals unaware of the benefits of CR, which leads to many cardiac patients being discharged home without any idea as to what they should do to maintain recovery and prevent further cardiac issues.

“It’s chronic disease self-management,” she explains. “The patient needs to understand what has happened to them in order to know what they need to do to prevent a recurrence. CR is not well-known, yet it has such tremendous impacts on patients’ quality of life and their future risk of disability or death.”

Working with KITE, the facilities, and the team at the Cardiovascular Prevention and Rehabilitation program led by Dr. Paul Oh have been critical in Dr. Colella’s research and the goal of increasing the effectiveness and reach of CR. Another key facilitator is involving patients as partners in the research team.

“We are fortunate to have a living lab in our CR program; we have patients coming in for program assessments, education, exercise, counselling and we’re recruiting patients from our population, and that is so important – having patients involved in the research process helps to optimize improving the patients’ journey. Thanks to KITE-UHN-Toronto Rehab we’ve had such strong support from that perspective.” 

The underrepresentation of women participating in CR is another challenge that Dr. Colella is targeting in her research. According to data from the Heart & Stroke Foundation of Canada, women are 50 per cent less likely than men to participate in cardiac rehabilitation. Dr. Colella stated that one of the main reasons is lack of referral and the misguided notion that women don’t need rehab.

Another more challenging issue is how women tend to be caregivers more than men. As Dr. Colella put it, “Women tend to put others at the forefront instead of putting their own health first.”

What are Dr. Colella and her colleagues doing to help ensure enrollment in CR increases for the people who need it? Filling the gap. According to Dr. Colella, the time between discharge from hospital and a CR program starting is about six to eight weeks. 

To help patients navigate the void, Dr. Colella and her colleagues  – including patient partners – developed and are currently testing an interactive and educational application called MyCaRe, which stands for My Cardiac Recovery.

“MyCaRe is provided to patients upon discharge, and they are encouraged to monitor pain level, wounds, mood, heart rate, blood pressure; patients input their information every day into this platform. They're given a Fitbit so we can also monitor their [physical] activity for six weeks in lead up to CR enrollment. Our team touches base with patients as needed to make sure everything is going well and if not, they can be referred back to the surgical clinic for assessment.” 

Feedback from patient volunteers thus far has been very good, she says. 

As for the future of CR, it’s all about virtual components, and taking personalization even further. 

“One aspect of virtual CR research is focused on development of AI knowledge around personalizing our virtual care programs in order to optimize participation and prevent dropout. Working closely with biomedical engineers including Dr. Shehroz Khan, we’re looking at how patients engage in CR, and whether we can identify when a patient becomes disengaged or at risk of program dropout. We’re also developing an avatar that will facilitate exercises for patients in their homes.”

Dr. Colella is on an important mission. She wants everyone to know that CR is not just an exercise program, and to understand how important it is to people who have had a heart-related event. 

“CR is based on the highest level of science and evidence as the next step in recovery following hospitalization for a cardiac event. As natural as going to the hospital to get your procedure done, CR is a key part of that next step in your continuum of care, and I honestly don't feel that this is well-publicized enough. CR makes a difference and improves life – not only quality of life but also years of life.”