Date: 20 February 2023; St Ives, Cambridgeshire.
After a life-changing event, such as a heart attack or bypass surgery, the NHS can provide many patients with cardiac rehabilitation programmes. This reduces the risk of death and future heart attacks and improves the quality of life for patients. However, only about half of those invited attend these NHS group-based programmes.
During the pandemic, many NHS cardiac rehabilitation (CR) services were moved online and saw an increase in patient uptake.
Now that in-person NHS cardiac rehabilitation services have restarted, there are increased pressures within healthcare: backlogs of people waiting, hospital gym facilities co-opted for other services or staff still returning from redeployment (against a backdrop of 7.2 million patients waiting for NHS care and a shortage of 110,000 staff).
Every in-person encounter between a patient and clinical staff is of great value (and cost). These can be made more impactful through the use of digitally delivered services, especially when provided in the patient's own home, saving time, money, reduction of carbon emissions and allowing working patients to attend at a more convenient time for them.
The NHS Long Term Plan¹ has the goal of increasing the number of eligible patients joining cardiac rehabilitation after a heart event from 50% to 85%.
Co-funded by Innovate UK, Aseptika is collaborating with the University of Birmingham, University of York and the National Audit of Cardiac Rehabilitation (NACR) to study the impact of a hybrid delivery of cardiac rehabilitation, which combines the best of in-person coaching, remote monitoring and patient education and support, in a new way of delivering this life-changing programme.
Professor Kate Jolly, Professor of Public Health & Primary Care at the Institute of Applied Health Research, University of Birmingham is leading the evaluation of the Aseptika system by using information that is routinely collected in an anonymised form by the NACR, which is a large database funded for use by the NHS throughout the UK.
Professor Jolly said: “This research project aims to explore new ways in which digitally delivered healthcare is tested with patients without the costs and long timelines associated with traditional clinical trials that can take many years to conduct. We will use anonymised data reported to the NACR to find out whether more patients take-up hybrid rehabilitation and whether the expected improvements in quality of life are seen, compared with pre-pandemic services which previously mainly offered in-person group-based delivery.”
The potential cost savings will be researched by Sebastian Hinde, a Research Fellow at the Centre for Health Economics at the University of York facilitated by in-kind funding from the NIHR Applied Research Collaboration (ARC) Yorkshire and Humber. “Understanding why patients do not take-up their place on the eight-week programme of cardiac rehabilitation is a complex issue. Many groups within society suffer health inequalities because they may have to return to work or live in isolated areas, are unable to afford transport, are themselves caring for a relative, do not have English as their first language, or do not like exercising in mixed sex classes. We already know that the cost of reaching the “next 35%” of patients who suffer from health inequalities is going to be higher. We will be exploring whether technology and in-person contact with patients can help the NHS achieve its long term plan and to do so in a cost-effective way.”
Active+me REMOTE for Cardiac Rehabilitation is already in use by the NHS in several hospitals. To support implementation and the hybrid delivery, funding from Innovate UK has supported Aseptika to hire a Cardiac Rehabilitation trainer to help NHS staff get the technology out to more patients.
Bernadette Gipson has joined Aseptika as the company’s Healthcare Services Support Manager from the public health sector and is qualified to deliver Cardiac Rehabilitation classes to Phase IV. “I am in awe of the technology the team at Aseptika has developed for Cardiac and Pulmonary rehabilitation. I will be directly supporting the NHS Cardiac Rehabilitation leads in the delivery of hybrid services and aim to reach as many patients as possible. Having delivered Cardiac Rehabilitation classes in the Peterborough area, I am keenly aware of the impact of rural isolation, poverty and the barriers to service access that many patients encounter, so I am excited to join Aseptika and to work alongside and support the NHS Cardiac Rehabilitation professionals in this new way of delivering this service.”
The 18-month project will result in a number of reports and joint publications to give feedback to the NHS and aims to reach up to 500 patients and follows a positive trial with Addenbrookes Hospital during the COVID-19 pandemic supported by Eastern Academic Health Sciences Network (EAHSN) and Innovate UK².
Caption: Patients using the Active⁺me REMOTE platform as part of their cardiac rehabilitation programme.
To view the video and see how Active⁺me REMOTE can help deliver hybrid cardiac rehabilitation, follow this link: https://youtu.be/5qXUtlVNeM0
The Active⁺me REMOTE App is an application for mobile devices intended for use in the home to assist people to receive and review information from connected medical and non-medical devices, track prescribe exercise and medication use, for effective health self-management as part of a hybrid cardiac rehabilitation service.
· Configurable and easy-to-use smartphone Apps.
· Track adherence to exercise, education and medication Care Plans.
· Add relevant, accurate devices wirelessly to monitor at home.
· Customer support available when you need it 7-days-a-week
Caption: Innovate UK Logo.
1. NHS Long-Term Plan. https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/
2. Changes in patient activation following cardiac rehabilitation using the Active⁺me digital healthcare platform during the COVID-19 pandemic: a cohort evaluation. BMC Health Serv Res 21, 1363 (2021). Gabbi Frith, Kathryn Carver, Sarah Curry, Alan Darby, Anna Sydes, Stephen Symonds, Katrina Wilson, Gordon McGregor, Kevin Auton & Simon Nichols.
Further information
Activ8rlives, Activ8rlives.com, Asthma⁺me, Active⁺me REMOTE and PUFFClicker are trademarks of Aseptika Ltd.
For further details, please contact Jessica Auton on +44 (0)1480 352 821 or email jessica.auton@aseptika.com
For a case study of the use of Active+me REMOTE to support Cardiac Rehabilitation, follow this link
Aseptika Ltd www.activ8rlives.com
Aseptika Ltd began developing Activ8rlives in 2010 and is currently developing its fourth generation of integrated systems, which can be used by consumers and their healthcare service providers using a wide range of platforms or devices to better enable effective and easy self-monitoring. Incorporating sensors and monitors ranging from consumer accessories to in vitro diagnostics (IVDs). Our focus is: respiratory and cardiovascular disease, cancer, promoting physical activity and weight management. Aseptika Limited has been certified by BSI to ISO 13485:2016 under certificate number MD691414, is certified for Cyber Essentials Plus, NHS Data Security and Protection Toolkit. Active⁺me REMOTE is a Class I medical device, UKCA and CE marked (under MDD).
University of Birmingham www.birmingham.ac.uk/research/applied-health
The University of Birmingham is a public research university located in Edgbaston, Birmingham, United Kingdom. It received its royal charter in 1900 as a successor to Queen's College, Birmingham (founded in 1825 as the Birmingham School of Medicine and Surgery) and Mason Science College (established in 1875 by Sir Josiah Mason), making it the first English civic or 'red brick' university to receive its own royal charter. It is a founding member of both the Russell Group of British research universities and the international network of research universities, Universitas.
The student population includes 23,155 undergraduate and 12,605 postgraduate students in 2019–20, which is the 7th largest in the UK (out of 169). The annual income of the university for 2021–22 was £869.8 million of which £215.0 million was from research grants and contracts, with an expenditure of £1.02 billion. In the 2021 Research Excellence Framework, the University of Birmingham ranked equal 13th out of 129 institutions on grade point average.
University of York www.york.ac.ul
The University of York is a collegiate research university, located in the city of York, England. Established in 1963, the university has expanded to more than thirty departments and centres, covering a wide range of subjects.
Situated to the south-east of the city of York, the university campus is about 500 acres (200 hectares) in size. The original campus, Campus West, incorporates the York Science Park and the National Science Learning Centre and its wildlife, campus lakes and greenery are prominent. In May 2007 the university was granted permission to build an extension to its main campus on arable land just east of the nearby village of Heslington. The second campus, Campus East, opened in 2009 and now hosts five colleges and three departments as well as conference spaces, a sports village and a business start-up 'incubator'. The institution also leases King's Manor in York city centre. The university had a total income of £403.6 million in 2020/21, of which £69.8 million was from research grants and contracts.
National Audit of Cardiac Rehabilitation https://digital.nhs.uk/data-and-information/clinical-audits-and-registries/national-audit-of-cardiac-rehabilitation
The National Audit of Cardiac Rehabilitation (NACR) collects comprehensive audit data to support the monitoring and improvement of cardiovascular prevention and rehabilitation services in terms of access, equity in provision, quality and clinical outcomes.
Established in 2005, NACR is managed by a team based in the Department of Health Sciences at the University of York. Informatics and data management services are provided by NHS Digital (now part of NHS England).
The NACR aims to increase the availability and uptake of cardiovascular prevention and rehabilitation, promote best practice and improve service quality in cardiovascular prevention and rehabilitation services by:
· Informing local and national planners, providers and commissioners where services are not reaching expected standards as defined in key national guidance.
· Identifying inequitable provision so that local providers of cardiac rehabilitation can formulate appropriate business plans and work towards all patients having an equal opportunity to benefit.
· Describing the typical gains that a patient can expect from cardiac rehabilitation against which the effectiveness of individual programmes can be judged.
· Examining reasons for variation in patient outcomes between programmes, so that services can be helped to improve.
· Sharing national trend data with appropriate national bodies including the Department of Health, NHS England, National Institute for Clinical Excellence (NICE), Cardiovascular Care Partnership UK and the British Association for Cardiovascular Prevention & Rehabilitation (BACPR).
Note - The audit works alongside many stakeholders, organisations and companies that share in the aims of improving uptake and service quality. However, the naming of individual modes of delivery on the database or being involved in research for a specific intervention does not equate to an endorsement by the audit. All delivery of cardiac rehabilitation should be evidenced based and covered by NICE guidance and the BACPR Standards and Core Components.