Self-Management-Centric Cardiac Rehabilitation for Acute Coronary Syndrome Patients During the COVID-19 Pandemic

Abstract

Background: The COVID-19 pandemic accelerated the adoption of home-based cardiac telerehabilitation (HBCTR), yet evidence on the role of intensified self-management in outcomes for acute coronary syndrome (ACS) patients remains limited. Material/Methods: In this single-center retrospective cohort study (2019-2021), 1627 ACS patients were stratified into 2 groups: those who finished a self-management-centric HBCTR (SMCCRF) plan, and the SMCCR-unfinished (SMCCRNF) group (31 missed tele-coaching sessions). The primary outcome was major adverse cardiac events (MACEs); secondary outcomes included self-perceived disease awareness assessed by the Coronary Artery Disease Education Questionnaire-Short Version (CADEQ-SV), behavioral metrics (medication adherence, physical exercise), and risk factor control. Propensity score matching (1: 1, calliper=0.1 standard deviation) generated 619 matched pairs. Results: Over a median follow-up of 23.39 months, the SMCCRF group had lower MACEs rates compared to the SMCCRNF group (7.43% vs 18.74%; HR 0.43, 95% CI 0.30-0.60; P<0.001), with consistent benefits across subgroups. Secondary outcomes favored the SMCCRF group, including higher CADEQ-SV scores at 12 and 36 months (P=0.02), better medication and exercise adherence (both P<0.001), and improved control of blood pressure, low-density lipoprotein cholesterol, and smoking cessation (all P<0.01). However, changes in cardiac function were similar between the 2 groups, and fluctuations of the aforementioned secondary outcomes were observed during long-term follow-up. Conclusions: SMCCR was associated with reduced cardiovascular risk and enhanced behavioral outcomes in ACS patients during the pandemic, suggesting a dose-dependent relationship between missed sessions and adverse outcomes. The findings support integrating self-management strategies into post-ACS care, pending validation in prospective trials.