A RE-AIM Analysis of a Co-Designed Web-Based Cardiac Rehabilitation Program in Rural and Remote South Australia: An Implementation Study

Introduction
Involvement in cardiac rehabilitation programs reduces death and reoccurring cardiac events, but CR attendance is poor globally. The aim of the project was to evaluate the effectiveness of a co-designed, interactive web-based CR program as an alternative mode of delivery to improve access and attendance.

Method
This study reports on the outcomes from the implementation process evaluation utilising a descriptive observational prospective study design guided by the RE-AIM framework.

Results
A total of 828 rural patients were enrolled in CR, with 50 choosing the web-based CR program. Web patients were younger, 60 years (SD±11.9) versus 68.5 years (SD±11.9). The proportion of males did not differ between web 17 (34%) and usual care 195 (23.5%, p=0.167). Program completion was higher for usual care than for the web-based patients (17, 34% v. 553, 71.4%, p<0.001). Web-based patients reported a positive overall experience (77.8%). Clinicians reported the web-based program as high quality (71.4%). Patient fidelity to entry of self-reported data was high for the web-based patients, with all patients completing a pre-assessment. Web-based program enrolment was associated with a lower chance of CR completion (OR 0.19; 95% CI: 0.10, 0.37; p<0.001) after adjustment for age and gender.

Conclusion
The web-based program provides an alternative flexible mode to complete CR. It has been integrated and successfully used by patients and clinicians, capturing a cohort not attending a CR program. Strategies for improving the completion of web-based programs need further investigation.