Promoting Accessible Rehab

Dr. Sherry Grace is on a mission to promote accessible cardiovascular rehabilitation.

Cardiovascular disease is a leading cause of death and disability. It is well established that cardiac rehab is the best way to reduce risk, but far too few patients are getting the care they need. 

KITE Research Institute Senior Scientist Dr. Sherry Grace is on mission to change this.

“Cardiac rehabilitation is a holistic chronic disease management program that saves lives,” she says. Patients who participate in cardiac rehab are also less likely to be re-hospitalized. This reduces anxiety in families, but also frees up bed space to lower hospital wait times. 

“When more patients are attending cardiac rehab, fewer will have health complications, which also means more of these patients can return to work and other valued life roles sooner,” Dr. Grace says. “This means better quality of life for patients, but also more taxpayer dollars can go towards improving our healthcare system overall.” 

The first step in cardiac rehab is an assessment to get an understanding of a patient’s various clinical conditions, psychosocial status, and goals. During this assessment, the doctor will also look at medical risk factor management, like cholesterol and blood pressure, she says. 

Then the patients start structured exercise, which they can perform under supervision or independently at home. Also included in the program are patient education for behaviour changes, and counselling for psychosocial well-being. 

These programs last about five months on average, with patients coming to the site twice a week for an hour each time. 

But according to research, cardiac rehab programs are used by too few patients, and even fewer of those who are marginalized, Dr. Grace says. This gap means patients and their families suffer, and results in higher health care costs for society.

Dr. Grace has dedicated her career to improving access to cardiac rehab. Since completing her PhD, she has been working at University Health Network, joining Toronto Rehab’s KITE when they merged in 2011. In addition to her role at KITE, she is also a professor in the Faculty of Health at York University.

Dr. Grace focusses her research on overcoming barriers to cardiac rehab participation, such as increasing program capacity, ensuring patients are referred, and that programs better engage patients. 

For instance, Dr. Grace co-founded an international network of cardiac rehab champions and providers. Among their many activities, they audit the availability of rehab in relation to the burden of heart disease in every country of the world. Canada does quite well when we compare ourselves globally, she says, so we can share what is working here to promote rehab in areas where it is needed most. Dr. Grace also works with the World Health Organization to support cardiac rehab implementation in all member states. 

But even where there are programs, patients need to be referred by a doctor first. So, to get started, “the best recommendation is for individuals to speak with their doctors to get a referral if they can – especially with cardiovascular rehabilitation being free in Ontario,” Dr. Grace says.  

Dr. Grace’s research has established the benefits of automatic cardiac rehabilitation referral, which leverages electronic medical records to identify every patient who would benefit from cardiac rehab while they’re still in the hospital. Dr. Grace has worked to implement automatic referral at University Health Network, other centres in Canada, and recently with the U.S. Centers for Disease Control and Prevention. 

If the patient can get a referral but faces a logistical barrier to attending sessions, there are remote offerings for most cardiac rehab programs. With the remote offerings, patients speak with their coordinator for about 15 minutes a week on the phone or online, and are supported to work through the full program on their own time.

For the patients opting for remote rehab, KITE’s cardiovascular rehabilitation program has developed a “Cardiac College” online program. This can also help to reach more patients, she says. 

The Cardiac College program contains exercise videos and patient education that can be done at home. To increase accessibility, it is available in 10 languages, and is available and used around the world. 

Although it varies by jurisdiction, Dr. Grace showed that on average, about 25 per cent of patients enroll in cardiac rehabilitation. With automatic referral, she demonstrated this can be increased to 70 per cent — and potentially even more since COVID-19, as remote programs are more widely available now. 

But there is still more that needs to be done, she says. 

“Ideally, every patient with a heart issue would be automatically referred to a cardiac rehabilitation program, no matter where they live,” Dr. Grace says. “And, ideally, there would be accessible space for them in these programs, with trained staff providing care tailored to the patient’s individual needs.”