51 Impact of changes in the modes of cardiac rehabilitation delivery on exercise capacity and physical activity outcomes: an observational study

<h3>Background</h3> Since the COVID-19 pandemic in 2020, the mode of cardiac rehabilitation (CR) delivery in the UK has undergone significant changes, shifting from predominantly group-based to other modalities such as home-based CR. These changes aim to continue providing high-quality CR services to cardiac patients. <h3>Aim</h3> This study investigates whether changes in CR delivery modes impact fitness and physical activity (PA) outcomes, which are key goals of CR services. <h3>Methods</h3> A retrospective study design was employed using routine clinical data from the National Audit of Cardiac Rehabilitation (NACR) dataset for patients with Acute Coronary Syndrome (ACS) pre- post- COVID-19. Logistic regression analysis was utilized to explore the association between achieving the Minimal Clinically Important Difference (MCID) in fitness and PA outcomes across different factors. The population was divided into three groups based on the assessments they underwent: Incremental Shuttle Walk (ISWT), Six-Minute Walk Test (6MWT), and PA. <h3>Results</h3> A total of 27,826 ACS patients were categorized into three groups based on the assessments: ISWT (4,008), 6MWT (1,822), and PA (21,996). The findings indicated that patients were less likely to achieve MCID for ISWT and the recommended PA levels post-COVID-19 compared to before the pandemic (OR=0.824, P=0.019; OR=1.612, P&lt;0.001, respectively). Despite the dominance of home-based CR post-pandemic, it was associated with lower likelihoods of achieving the thresholds for ISWT, 6MWT, and recommended PA compared to group-based CR. <h3>Conclusion</h3> ACS patients improved their fitness and achieving MCID was associated with group-based CR. Due to the pandemic, mode of delivery became more diverse, however it appears an association with fitness and physical activity may be present as a wider patient profile received alternatives to group and an increased menu was offered. It is important to exercise caution and not assume that all modes of delivery are equal in terms of patient outcomes.