Heart & Stroke Foundation of Barbados Home-based Cardiac Rehabilitation
“Cardiac rehabilitation services are comprehensive, long-term programs involving medical evaluation, prescribed exercise, cardiac risk factor modification, education, and counselling. These programs are designed to limit the physiologic and psychological effects of cardiac illness, reduce the risk for sudden death or re-infarction, control cardiac symptoms, stabilize or reverse the atherosclerotic process, and enhance the psychosocial and vocational status of selected patients.” Thomas RJ, King M, Lui K, et al. AACVPR/ACC/AHA 2007
Cardiac Rehabilitation (CR) is strongly recommended by cardiovascular societal guidelines post cardiac events such as myocardial infarction or bypass surgery and we at the Heart & Stroke Foundation of Barbados (HSFB) Inc. have long recognised this.
The severe acute respiratory syndrome coronavirus disease 2019 (COVID-19) has led to widespread changes in the way healthcare is being administered worldwide. The practice of social distancing to decrease the likelihood of transmission of coronavirus means that traditional gym-based rehab programmes are inadvisable, especially since the target demographic are the ones at highest risk for complicated COVID-19. Home-based cardiac rehabilitation is an alternative for administration of cardiac rehabilitation. This form of CR may be offered to clients whose ability to come to a rehab centre is limited, either because of transportation or distance from the rehab centre, inability to schedule rehab visits due to employment, or disability. It is a tried and tested alternative approach to in-house cardiac rehab
Why would we at HSFB consider adopting this approach? Evidence suggests that delayed enrolment in cardiac rehabilitation leads to reduced engagement in the CR process. With the knowledge that delay in CR may be detrimental, then it becomes incumbent upon us to explore alternatives, in this case, HBCR.
The HSFB Cardiac Disease Prevention and Rehabilitation (CDPR) team is working to provide that continuity of care – starting with its Phase 2 clients. Who are those you might ask? Phase 2 cardiac rehabilitation starts following discharge from hospital after a cardiac event and continues for around 3 months. Our initial HBCR clients are patients who were already enrolled in centre-based CR before closure of operations. They had already been assessed, exercise prescriptions and individualized treatment plans developed, and had participated in at least one session in the CDPR gym.
How does it work?
Members of the nursing team have communicated with each client, explaining the purpose of the calls, and the importance of maintaining adherence to the programme. They have scheduled weekly telephone appointments which then proceed according to a very prescriptive approach. During these ‘appointments’, they discuss goals, vitals, diet, medication, exercise routines as well as overall health and wellbeing.
Looking ahead to integration of new clients.
As we monitor the situation in our country with respect to COVID-19, it will likely become necessary to develop protocols to enroll new clients while maintaining safe practices. These new clients will include patients who were either awaiting assessment at the onset of the lockdown, or have sustained a new cardiac event.
We are steadfastly working to serve the needs of our most vulnerable clientele and will be sure to keep you abreast as our plans continue to unfold during this period.
Heart & Stroke Foundation of Barbados Healthy and Lean in Quarantine Social Media Series
The Heart and Stroke Foundation of Barbados (HSFB) with support of the Global Health Advocacy Incubator (GHAI) launched a Childhood Obesity Prevention(COP) campaign in 2018, advocating for the implementation of strong policies to reduce childhood obesity and related Non-Communicable Diseases (NCDs).
Over the last two years, the HSFB’s COP team has been engaged in stakeholder advocacy and public education, calling firstly for policy to ban the sale and marketing of sugar sweetened beverages (SSBs) in and around all schools across Barbados. As part of this work, HSFB has engaged national influencers as Policy Champions and has helped to launch a Coalition of Civil Society Organisations (CSOs) to strengthen support for COP policy.
By mid-March 2020, as Barbados and the region started to tackle the challenges associated with COVID-19, HSFB supported the overall COVID-19 public education via the re-posting of all national Public Service Announcements (PSAs) on its social media platforms. However, HSFB soon noticed that the resulting national lockdown to deal with COVID-19, created another scenario for families which could lead to increased childhood obesity issues and the resulting NCDS post-COVID-19.
In response, on April 1st, 2020, HSFB’s COP team launched a video series across its social media platforms called ‘Healthy and Lean in Quarantine’. The series was aimed primarily at parents to promote the importance of positive nutrition practices; regular exercise and healthier snack choices during this period.
The series was scheduled to run four times a week for four weeks, that is a total of 16 videos which would first run organically and would then be boosted for wider public engagement.
The series was able to draw on HSFB’s existing partnerships and included video presentations from Dr Kia Lewis, one of our Coalition members; HSFB consultant and fitness instructor, Falicia Goodridge; Victoria Cox, a dietician with one of our CSOs, Barbados Diabetes Foundation (BDF) and our Policy Champion, entertainer, Carl Alff Padmore.
Initial analytics has suggested that the series is performing well organically and to date, HSFB has seen a very encouraging increase in followers during this period.
In keeping with its COP mandate, the Healthy and Lean in Quarantine series seeks to promote the protection of children through healthy lifestyle choices. The strength of this series has probably been the attempt to provide parents with simple ideas and tips that could be easily attained and maintained despite the current national lockdown. The series promoted the use of simple and affordable yet healthy products; drinking more water as opposed to SSBs and engaging the children in exercise activities which use objects that are found in the home and do not require large outdoor spaces.
Special thanks to our experts and our Policy Champion who provided all the content for these videos.