a study from the PROCARD research group

eCardiacRehab

In the project eCardiacRehab, a new digital cardiac rehabilitation will be developed and tested for patients who have undergone percutaneous coronary intervention. eCardiacRehab is a digital program that patients with coronary artery disease follow throughout their rehabilitation, at home in their own living room. This is a multimodal and interdisciplinary innovation and research project, with different work packages and many stakeholders involved.

Project leader: Prof Tone M. Norekvål

Project period: 2021 – 2027

Budget: NOK 33 mill

Financing: The Research Council of Norway, Helse Vest, InnoMed

«The program has several features in common with place based cardiac rehabilitation, only that the patient can do it at any time and at home in their own living room.»

Project Leader Prof. Tone M. Norekvål.

Substantial preparative work has been made, and the development of the eCardiacRehab is informed by published work from our CONCARDPCI study (3400 patients enrolled), including a systematic review on modes of eHealth delivery in secondary prevention programmes for patients with coronary artery disease, qualitative interview studies, and quantitative studies.

Cardiac rehabilitation (CR) is a class I recommendation in European and American guidelines as it reduce mortality, readmissions, and psychological distress, and improve self-management, health related quality of life and physical capacity in patients with coronary artery disease. In Norway, more than 12,000 patients undergo PCI every year.

Despite better treatment methods, these patients live with a chronic heart disease with implications for patients, clinicians, healthcare systems and the society. The majority of these patients (70-80%), are offered no CR due to high patient volume and few CR programmes. Furthermore, the rapid development of COVID-19 has provoked a need to re-think modes of healthcare delivery and to move beyond traditional place-based CR and embrace electronic health resources that connect care through the internet and related technologies. The eCardiacRehab project will make CR available to all patients undergoing PCI by taking advantage of new technological solutions and collaboration across different disciplines.

The innovative eCardiacRehab can meet the rehabilitation needs of large patient groups, regardless of their access to traditional place-based CR. eCardiacRehab is a person-centred eHealth programme moving health services from hospital to home aimed at guiding patients’ self-management and prevention of coronary artery disease. Patients will be offered eCardiacRehab after referral from a physician. eCardiacRehab will be accessible via a secure (safety level 4) and password-protected internet site for use on a computer, smartphone or tablet. We work closely with the section for eHealth and Helse Vest IKT in development of the digital solution. In addition, eCardiacRehab provides secure digital communication between patient and healthcare provider.

We have emphasized user involvement in the planning and design of the eCardiacRehab. The educational and informational materials offered in the eCardiacRehab programme includes tailored counselling, and health information according to patients' preferences, e.g., written material adapted to appropriate reading level, and use of visual elements and videos. The eCardiacRehab is developed in an interdisciplinary team to ensure that the information material is research-based and up-to-date.

eCardiacRehab has the potential to improve interaction and collaboration between primary and secondary care, modernise and digitalise work processes, and to develop more coherent and tailored patient pathways. All of which are focus areas in the national eHealth strategy (Nasjonal e-helsestrategi 2017-2022) and the Helse Vest strategy to develop the patient’s healthcare services (Helse2035). Furthermore, eCardiacRehab will reduce the variation in quality and availability of CR and improve patient pathways.

Research group leader

Tone M. Norekvål’s main position is at the Department of Heart Disease, Haukeland University Hospital, were she chairs the PROCARD research group. She is a registered nurse with a masters degree in nursing science and a PhD from the Faculty of Medicine at the University of Bergen. Norekvål holds a position as Professor II at the Department of Clinical Science, University of Bergen and at the Department of Health and Caring Sciences, Western Norway University of Applied Sciences. In addition, she is a special advisor at the Center on Patient-reported Outcomes at Haukeland University Hospital.

Norekvål has extensive leadership and project management experience from various positions at the Department of Heart Disease, as former chair of the Norwegian Nurses Association Society of Cardiovascular Nurses (NSF-LKS), former chair of the Council of Cardiovascular Nursing and Allied Professions, and member of the Education Committee and the Oversight Committee in the European Society of Cardiology (ESC). In addition, Norekvål has participated in several ESC Task Forces and contributed on development of ESC Guidelines. Furthermore, Norekvål holds several national appointed positions, such as board member in the Norwegian Council on Cardiovascular Disease and the Norwegian Heart Failure Registry. Norekvål is associated editor of the European Journal of Cardiovascular Nursing and editorial board member in Cardiology.

Teaching and supervision
Norekvål teaches at the Master Program in Clinical Nursing (Cardiovascular Nursing), at the Western Norway University of Applied Sciences. She has been main supervisor for more than 20 completed master degrees in clinical nursing and radiography, and several more are ongoing. Norekvål has been main supervisor on four completed PhD-thesis, and is main supervisor for six ongoing PhD-candidates.

Research interest
Tone M. Norekvål initiated and chairs the PROCARD research group at the Department of Heart Disease. Her research is mainly linked to patient-reported outcome measures (PRO) and cardiac patients and includes patients with coronary artery disease, arrhythmia, valvular disease and heart failure. In addition, Norekvål chairs the research programme on patient-reported data in the Helse-Bergen Health Trust.
E-mail: tone.merete.norekvål@helse-bergen.no

Publications

Department of Heart Disease, Haukeland University Hospital
Occupation: Postdoctoral Research Fellow / Nurse in research and development,
Education: Specialized in cardiovascular nursing, MSc in cardiovascular nursing, PhD
Field of research: Medication adherence after PCI (CONCARD), arrhythmias, digital cardiac rehabilitation
E-mail: trond.roed.pettersen@helse-bergen.no
Publications

Clinical Research Nurses

Workplace: Heart Intervention (HINT), Cath Lab, Haukeland University Hospital

Job title: Specialist Nurse in Cardiological Nursing
Education: Master’s Degree in Cardiological Nursing
Email: kristin.rykkje-johannessen@helse-bergen.no

Workplace: Heart Clinic, Haukeland University Hospital
Job title: Clinical research nurse, eCardiacRehab
Email: mona.lavik@helse-bergen.no

Senior Researchers

Western Norway University of Applied Sciences, Campus Førde
Occupation: Associated professor
Education: Specialized in cardiovascular nursing, MSc in organization and management
Field of research: Continuity of care in patients undergoing PCI (PROCARD)
E-mail: irene.valaker@hvl.no
Publications

Department of Heart Disease, Haukeland University Hospital
Occupation: PhD student
Education: Specialized in geriatric nursing, MSc in Health Sciences
Field of research: Health and disease management in octogenarians and nonagenarians after PCI (CONCARD), delirium.
E-mail: irene.instenes@helse-bergen.no

Publications

Doctoral Research Fellows

Western Norway University of Applied Sciences, Campus Bergen.

The Cardiac Unit, Department of Heart Disease, Haukeland University Hospital
Occupation: PhD student, Specialized in cardiovascular nursing
Education: MSc in cardiovascular nursing
Field of research: eHealth literacy and medication adherence after PCI (CONCARDPCI, eCardiacRehab), co-creation in development of a digital cardiac rehabilitation programme
E-mail: kristin.johnsen.ramstad@helse-bergen.no / kristin.johnsen.ramstad@hvl.no

Publication: eHealth technology use and eHealth literacy after percutaneous coronary intervention - PubMed (nih.gov)

Workplace: Heart Clinic, Haukeland University Hospital
Job title: PhD Research Fellow
Education: Master’s in Human Nutrition and Master’s in Health and Society
Research Area: Diet, nutrition, and cardiometabolic health in digital cardiac rehabilitation after PCI (CONCARDPCI, eCardiacRehab)

Email: katrine.nicole.naranjo@helse-bergen.no

Workplace: Medical Intermediate Monitoring and Cardiac Ward/Cardiac Outpatient Clinic, Haugesund Hospital
Job title: PhD Research Fellow, Specialist Nurse in Cardiological Nursing
Education: Master’s Degree in Clinical Nursing, Cardiological Nursing
Research Area: Quality of life in patients with heart failure and implanted cardiac defibrillator
Publication: DOI: 10.4220/Sykepleiens.2019.76099
Email: hanne.flagtvedt@helse-fonna.no

Workplace: Heart Clinic (Heart Ward 1s2v), Haukeland University Hospital
Job title: Specialist Nurse in Cardiological Nursing
Education: Master’s in Clinical Nursing – Cardiological Nursing
Research Area: Modifiable risk factors and self-reported health in patients with and without atrial fibrillation after PCI (CONCARDPCI)
Email: anniken.juvik.kjolseth@helse-bergen.no