Cardiac Rehabilitation in Post COVID-19 Patients with Cardiovascular Diseases Complipication: Review Article
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Published:
Jun 27, 2024
Keywords:
cardiac rehabilitation, cardiovascular complications, cardiovascular disease, COVID-19, sars-cov-2
Main Article Content
Abstract
Abstract
Introduction: The outbreak of COVID-19 has been linked to an increased risk to heart health, emphasizing the significance of Cardiac Rehabilitation (CR) in tackling these concerns. This review is intended to improve comprehension of the effects of COVID-19 on cardiovascular health and to assist healthcare providers in their care of patients.
Methods:This study employs a comprehensive literature review covering 2019 to 2021, using keywords "Sars-Cov-2" OR "COVID-19" AND "Cardiovascular Diseases" AND "Cardiac Rehabilitation" across various databases. After screening, 321 articles yielded 32 studies for the pooled analysis.
Results: During the outbreak, 14.4% of the individuals developed acute cardiovascular issues, with a mortality rate ranging from 5.6% to 10.5%, surpassing the seasonal flu mortality rates. Patients post-COVID-19 exhibit similar clinical manifestations, necessitating rehabilitation to enhance their quality of life and prevent future complications. Amidst the pandemic, cardiac rehabilitation centers have shifted to virtual or telemedicine rehabilitation owing to interruptions in regular services.
Discussion: COVID-19 commonly triggers myocarditis, heart failure (HF), arrhythmias, and venous thromboembolism (VTE). Pre-hospital diagnostics and post-discharge follow-up via telemedicine rehabilitation present effective strategies for managing patients with cardiovascular disease (CVD), offering additional clinical insights for cardiologists to diagnose and differentially diagnose patients without in-person consultations.
Conclusion: COVID-19 survivors face potential CVD complications, underscoring the need for CR to improve the quality of life and mitigate CVD risks post-exposure. This rehabilitation approach holds promise for reducing mortality among patients with post-COVID-19 heart disease.
Introduction: The outbreak of COVID-19 has been linked to an increased risk to heart health, emphasizing the significance of Cardiac Rehabilitation (CR) in tackling these concerns. This review is intended to improve comprehension of the effects of COVID-19 on cardiovascular health and to assist healthcare providers in their care of patients.
Methods:This study employs a comprehensive literature review covering 2019 to 2021, using keywords "Sars-Cov-2" OR "COVID-19" AND "Cardiovascular Diseases" AND "Cardiac Rehabilitation" across various databases. After screening, 321 articles yielded 32 studies for the pooled analysis.
Results: During the outbreak, 14.4% of the individuals developed acute cardiovascular issues, with a mortality rate ranging from 5.6% to 10.5%, surpassing the seasonal flu mortality rates. Patients post-COVID-19 exhibit similar clinical manifestations, necessitating rehabilitation to enhance their quality of life and prevent future complications. Amidst the pandemic, cardiac rehabilitation centers have shifted to virtual or telemedicine rehabilitation owing to interruptions in regular services.
Discussion: COVID-19 commonly triggers myocarditis, heart failure (HF), arrhythmias, and venous thromboembolism (VTE). Pre-hospital diagnostics and post-discharge follow-up via telemedicine rehabilitation present effective strategies for managing patients with cardiovascular disease (CVD), offering additional clinical insights for cardiologists to diagnose and differentially diagnose patients without in-person consultations.
Conclusion: COVID-19 survivors face potential CVD complications, underscoring the need for CR to improve the quality of life and mitigate CVD risks post-exposure. This rehabilitation approach holds promise for reducing mortality among patients with post-COVID-19 heart disease.
Article Details
How to Cite
Sari, D. M., Khairunnisa, A., Wijaya, L. C. G., Santoso, P. H. C., Prameswari, H. S., Iqbal, M., & Sastradimaja, S. B. (2024). Cardiac Rehabilitation in Post COVID-19 Patients with Cardiovascular Diseases Complipication: Review Article. Indonesian Journal of Physical Medicine and Rehabilitation, 13(01), 57 - 73. https://doi.org/10.36803/indojpmr.v13i01.409
Section
Literature Review
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References
1. Veska D. Frequently asked questions about coronavirus disease (covid-19). Novel Coronavirus (COVID-19): What you should know - UNICEF Indonesia. https://www.unicef.org/indonesia/coronavirus/FAQ. Accessed 5th Oct 2021
2. European Society of Cardiology. Guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Eur Heart J. 2022; 43:1033–1058. Doi:10.1093/eurheartj/ehab696
3. Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and Cardiovascular Disease. J Circulation. 2020;141(20):1648–1655. doi: 10.1161/CIRCULATIONAHA.120.046941.
4. Maričić L, Mihić D, Sušić L, Loinjak D. COVID-19 Cardiac Complication- Myocarditis. J Open COVID. 2021; 1:1–5. doi:10.2174/2666958702101010001
5. Taylor RS, Dalal HM, McDonagh STJ.The role of cardiac rehabilitation in improving cardiovascular outcomes. Nature Reviews Cardiology. 2022; 19:180–194
6. Van Iterson EH, Laffin LJ, Crawford M, et al. Cardiac Rehabilitation Is Essential in the COVID-19 Era: Delivering Uninterrupted Heart Care Based On The Cleveland Clinic Experience. J Cardiopulmonary Rehabilitation and Prev. 2021; 41:88–92. doi:10.1097/HCR.0000000000000585
7. Lim SL, Woo KL, Lim E, et al. Impact of COVID-19 on health-related quality of life in patients with cardiovascular disease: a multi-ethnic Asian study. J Health and Quality of Life Outcomes. 2020; 18:1–7. doi:10.1186/s12955-020-01640-5
8. Ambrosetti M, Abreu A, Cornelissen V, et al. Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era. J Eur Prev Cardiol. 2021; 28:541–557. doi:10.1093/eurjpc/zwaa080
9. Pavli A, Theodoridou M, Maltezou HC. Post-COVID Syndrome: Incidence, Clinical Spectrum, and Challenges for Primary Healthcare Professionals. Arch Med Research. 2021; 52:575–581. doi:10.1016/j.arcmed.2021.03.010
10. Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. J Nature Med. 2021; 27(4):601–615. doi: 10.1038/s41591-021-01283-z
11. CDC. Post-COVID Conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. Accessed 25th Dec 2021
12. Sarfraz Z, Sarfraz A, Barrios A, et al. Cardio-Pulmonary Sequelae in Recovered COVID-19 Patients: Considerations for Primary Care. J Primary Care and Community Health. 2021; 12. doi:10.1177/21501327211023726
13. Jaiswal V, Sarfraz Z, Sarfraz A, et al. COVID-19 Infection and Myocarditis: A State-of-the-Art Systematic Review. J Primary Care and Community Health. 2021; 12. doi:10.1177/21501327211056800
14. Nicholls SJ, Nelson M, Astley C, et al. Optimising Secondary Prevention and Cardiac Rehabilitation for Atherosclerotic Cardiovascular Disease During the COVID-19 Pandemic: A Position Statement From the Cardiac Society of Australia and New Zealand (CSANZ). J Heart Lung and Circulation. 2020; 29(7):99–104. doi: 10.1016/j.hlc.2020.04.007
15. Besnier F, Gayda M, Nigam A, et al. Cardiac Rehabilitation During Quarantine in COVID-19 Pandemic: Challenges for Center-Based Programs. Arch Phys Med and Rehabilitation. 2020; 101(10):1835–1838. doi: 10.1016/j.apmr.2020.06.004
16. Fersia O, Bryant S, Nicholson R, et al. The impact of the COVID-19 pandemic on cardiology services. J Open Heart. 2020; 7. doi:10.1136/openhrt-2020-001359
17. Mureddu GF, Ambrosetti M, Venturini E, et al. Cardiac rehabilitation activities during the COVID-19 pandemic in Italy. Position paper of the AICPR (Italian Association of Clinical Cardiology, Prevention and Rehabilitation). Monaldi Arch for Chest Disease. 2020; 90:353–366. doi:10.4081/MONALDI.2020.1439
18. Percy E, Luc JGY, Vervoort D, et al. Post-Discharge Cardiac Care in the Era of Coronavirus 2019: How Should We Prepare? Canadian J Cardiology. 2020; 36:956–960. doi:10.1016/j.cjca.2020.04.006
19. Bader F, Manla Y, Atallah B, Starling RC. Heart failure and COVID-19. Heart Failure Rev. 2021; 26(1):1-10. doi: 10.1007/s10741-020-10008-2
20. Swarnakar R, Resident J, Dev K, et al ReCOVer study: A Cross-sectional Observational Study to Identify the Rehabilitation Need in Post-discharge COVID-19 Survivors Authors. doi:10.1101/2021.04.19.21255750
21. Wong C, Mansoor A, Mcginn T. A Cross-sectional Study of Clinical COVID-19 Myocarditis: Differences in Biomarkers in Fulminant and Non-fulminant Cases. 2021. doi:10.1101/2021.06.06.21258423
22. O’gallagher K, Shek A, Bean DM, et al. Pre-existing cardiovascular disease rather than cardiovascular risk factors drives mortality in COVID-19. BMC Cardiovasc Disord. 2021; 21(327). doi:10.1101/2020.12.02.20242933
23. Sardinha DM, Lima KV, Ueno TM, et al. Occurrence of cardiovascular complications associated with SARS-CoV-2 infection: a systematic review. J Pharmaceutical Research Int. 2020. doi:10.1101/2020.11.14.20231803
24. Hamam O, Goda A, Eldalal M, et al. Cardiac Arrhythmias in Patients with COVID-19: A Systematic review and Meta-analysis. 2020. doi:10.1101/2020.10.09.20209379
25. al Tamimi H, Alhamad Y, Khazaal F, et al. The Outcome of COVID-19 Patients with Acute Myocardial Infarction. 2020. doi:10.1101/2020.07.21.20156349
26. Caraballo C, McCullough M, Fuery MA, et al. COVID-19 infections and outcomes in a live registry of heart Failure patients across an integrated health care system. 2020. doi:10.1101/2020.04.27.20082016
27. Lala A, Johnson KW, Januzzi JL, et al. Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection. J Am Coll Cardiol. 2020; 76:533–546. doi:10.1016/j.jacc.2020.06.007
28. Henrina J, Santosa Putra IC, Cahyadi I, et al. Clinical characteristics and outcomes of Venous Thromboembolism in patients hospitalized for COVID-19: Systematic review and meta-analysis. Thrombosis Update. 2020. doi:10.1101/2020.06.14.20130922
29. Thakkar S, Arora S, Kumar A, et al. A systematic review of the cardiovascular manifestations and outcomes in the setting of coronavirus-19 disease. 2020. doi:10.1101/2020.08.09.20171330
30. Aiyegbusi OL, Hughes SE, Turner G, et al. Symptoms, complications and management of long COVID: a review. J R Soc Med. 2021; 114:428–442
31. Batalik L, Konecny V, Dosbaba F, et al. Cardiac rehabilitation based on the walking test and telerehabilitation improved cardiorespiratory fitness in people diagnosed with coronary heart disease during the covid-19 pandemic. J Environmental Research and Public Health. 2021; 18:1–11. doi:10.3390/ijerph18052241
32. Ma L, Xiong X, Yan L, et al. Home-based exercise is associated with improved cardiac functional performance in patients after acute myocardial infarction. J Int Med Research. 2020; 48. doi:10.1177/0300060520977637
33. Thamman R, Janardhanan R. Cardiac rehabilitation using telemedicine: the need for tele cardiac rehabilitation. J Cardiovascular Med. 2020; 21:497–500. doi:10.31083/j.rcm.2020.04.201
34. Cavalheiro AH, Silva Cardoso J, Rocha A, et al. Effectiveness of Telerehabilitation Programs in Heart Failure: A Systematic Review and Meta-analysis. J Health Services Insights. 2021; 14. doi: 10.1177/11786329211021668
35. Scherrenberg M, Wilhelm M, Hansen D, et al. The future is now: A call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology. J European of Preventive Cardiology. 2021; 28:524–540. doi:10.1177/2047487320939671
36. Kato M, Ono S, Seko H, et al. Trajectories of frailty, physical function, and physical activity levels in elderly patients with heart failure: Impacts of interruption and resumption of outpatient cardiac rehabilitation due to COVID-19. J International of Rehabilitation Research. 2021 doi:10.1097/MRR.0000000000000473
37. Moulson N, Bewick D, Selway T, et al. Cardiac Rehabilitation During the COVID-19 Era: Guidance on Implementing Virtual Care. J Canadian of Cardiology. 2020; 36:1317–1321. doi:10.1016/j.cjca.2020.06.006
38. Nan J, Jia R, Meng S, et al. The Impact of the COVID-19 Pandemic and the Importance of Telemedicine in Managing Acute ST Segment Elevation Myocardial Infarction Patients: Preliminary Experience and Literature Review. J Med Syst. 2021; 45(9). doi:10.1007/s10916-020-01703-6/Published
39. Beleigoli A, Champion S, Tirimacco R, et al. A co-designed telehealth-based model of care to improve attendance and completion to cardiac rehabilitation of rural and remote Australians: The Country Heart Attack Prevention (CHAP) project. J Telemedicine and Telecare. 2021; 27:685–690. doi:10.1177/1357633X211048400
40. Scott-Sheldon LAJ, Gathright EC, Wu W-C. Promoting Social Connectedness among Cardiac Rehabilitation Patients During the COVID-19 Pandemic and Beyond. R I Med J. 2013; 103(9):34-35
41. Scherrenberg M, Falter M, Dendale P. Patient experiences and willingness-to-pay for cardiac telerehabilitation during the first surge of the COVID-19 pandemic: single-centre experience. Acta Cardiol. 2021; 76(2):151–157. doi:10.1080/00015385.2020.1846920
42. de Melo Ghisi GL, Xu Z, Liu X, et al. Impacts of the COVID-19 Pandemic on Cardiac Rehabilitation Delivery around the World. Glob Heart J. 2020; 16(1):43. doi:10.5334/gh.939
43. Jaiswal V, Nagpal S, Labitag CAE, et al. A Systematic Review of COVID-19 Induced Myocarditis-Symptomatology, Prognosis, and Clinical Findings. 2021 doi:10.1101/2021.05.29.21258059
2. European Society of Cardiology. Guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Eur Heart J. 2022; 43:1033–1058. Doi:10.1093/eurheartj/ehab696
3. Clerkin KJ, Fried JA, Raikhelkar J, et al. COVID-19 and Cardiovascular Disease. J Circulation. 2020;141(20):1648–1655. doi: 10.1161/CIRCULATIONAHA.120.046941.
4. Maričić L, Mihić D, Sušić L, Loinjak D. COVID-19 Cardiac Complication- Myocarditis. J Open COVID. 2021; 1:1–5. doi:10.2174/2666958702101010001
5. Taylor RS, Dalal HM, McDonagh STJ.The role of cardiac rehabilitation in improving cardiovascular outcomes. Nature Reviews Cardiology. 2022; 19:180–194
6. Van Iterson EH, Laffin LJ, Crawford M, et al. Cardiac Rehabilitation Is Essential in the COVID-19 Era: Delivering Uninterrupted Heart Care Based On The Cleveland Clinic Experience. J Cardiopulmonary Rehabilitation and Prev. 2021; 41:88–92. doi:10.1097/HCR.0000000000000585
7. Lim SL, Woo KL, Lim E, et al. Impact of COVID-19 on health-related quality of life in patients with cardiovascular disease: a multi-ethnic Asian study. J Health and Quality of Life Outcomes. 2020; 18:1–7. doi:10.1186/s12955-020-01640-5
8. Ambrosetti M, Abreu A, Cornelissen V, et al. Delphi consensus recommendations on how to provide cardiovascular rehabilitation in the COVID-19 era. J Eur Prev Cardiol. 2021; 28:541–557. doi:10.1093/eurjpc/zwaa080
9. Pavli A, Theodoridou M, Maltezou HC. Post-COVID Syndrome: Incidence, Clinical Spectrum, and Challenges for Primary Healthcare Professionals. Arch Med Research. 2021; 52:575–581. doi:10.1016/j.arcmed.2021.03.010
10. Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. J Nature Med. 2021; 27(4):601–615. doi: 10.1038/s41591-021-01283-z
11. CDC. Post-COVID Conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. Accessed 25th Dec 2021
12. Sarfraz Z, Sarfraz A, Barrios A, et al. Cardio-Pulmonary Sequelae in Recovered COVID-19 Patients: Considerations for Primary Care. J Primary Care and Community Health. 2021; 12. doi:10.1177/21501327211023726
13. Jaiswal V, Sarfraz Z, Sarfraz A, et al. COVID-19 Infection and Myocarditis: A State-of-the-Art Systematic Review. J Primary Care and Community Health. 2021; 12. doi:10.1177/21501327211056800
14. Nicholls SJ, Nelson M, Astley C, et al. Optimising Secondary Prevention and Cardiac Rehabilitation for Atherosclerotic Cardiovascular Disease During the COVID-19 Pandemic: A Position Statement From the Cardiac Society of Australia and New Zealand (CSANZ). J Heart Lung and Circulation. 2020; 29(7):99–104. doi: 10.1016/j.hlc.2020.04.007
15. Besnier F, Gayda M, Nigam A, et al. Cardiac Rehabilitation During Quarantine in COVID-19 Pandemic: Challenges for Center-Based Programs. Arch Phys Med and Rehabilitation. 2020; 101(10):1835–1838. doi: 10.1016/j.apmr.2020.06.004
16. Fersia O, Bryant S, Nicholson R, et al. The impact of the COVID-19 pandemic on cardiology services. J Open Heart. 2020; 7. doi:10.1136/openhrt-2020-001359
17. Mureddu GF, Ambrosetti M, Venturini E, et al. Cardiac rehabilitation activities during the COVID-19 pandemic in Italy. Position paper of the AICPR (Italian Association of Clinical Cardiology, Prevention and Rehabilitation). Monaldi Arch for Chest Disease. 2020; 90:353–366. doi:10.4081/MONALDI.2020.1439
18. Percy E, Luc JGY, Vervoort D, et al. Post-Discharge Cardiac Care in the Era of Coronavirus 2019: How Should We Prepare? Canadian J Cardiology. 2020; 36:956–960. doi:10.1016/j.cjca.2020.04.006
19. Bader F, Manla Y, Atallah B, Starling RC. Heart failure and COVID-19. Heart Failure Rev. 2021; 26(1):1-10. doi: 10.1007/s10741-020-10008-2
20. Swarnakar R, Resident J, Dev K, et al ReCOVer study: A Cross-sectional Observational Study to Identify the Rehabilitation Need in Post-discharge COVID-19 Survivors Authors. doi:10.1101/2021.04.19.21255750
21. Wong C, Mansoor A, Mcginn T. A Cross-sectional Study of Clinical COVID-19 Myocarditis: Differences in Biomarkers in Fulminant and Non-fulminant Cases. 2021. doi:10.1101/2021.06.06.21258423
22. O’gallagher K, Shek A, Bean DM, et al. Pre-existing cardiovascular disease rather than cardiovascular risk factors drives mortality in COVID-19. BMC Cardiovasc Disord. 2021; 21(327). doi:10.1101/2020.12.02.20242933
23. Sardinha DM, Lima KV, Ueno TM, et al. Occurrence of cardiovascular complications associated with SARS-CoV-2 infection: a systematic review. J Pharmaceutical Research Int. 2020. doi:10.1101/2020.11.14.20231803
24. Hamam O, Goda A, Eldalal M, et al. Cardiac Arrhythmias in Patients with COVID-19: A Systematic review and Meta-analysis. 2020. doi:10.1101/2020.10.09.20209379
25. al Tamimi H, Alhamad Y, Khazaal F, et al. The Outcome of COVID-19 Patients with Acute Myocardial Infarction. 2020. doi:10.1101/2020.07.21.20156349
26. Caraballo C, McCullough M, Fuery MA, et al. COVID-19 infections and outcomes in a live registry of heart Failure patients across an integrated health care system. 2020. doi:10.1101/2020.04.27.20082016
27. Lala A, Johnson KW, Januzzi JL, et al. Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection. J Am Coll Cardiol. 2020; 76:533–546. doi:10.1016/j.jacc.2020.06.007
28. Henrina J, Santosa Putra IC, Cahyadi I, et al. Clinical characteristics and outcomes of Venous Thromboembolism in patients hospitalized for COVID-19: Systematic review and meta-analysis. Thrombosis Update. 2020. doi:10.1101/2020.06.14.20130922
29. Thakkar S, Arora S, Kumar A, et al. A systematic review of the cardiovascular manifestations and outcomes in the setting of coronavirus-19 disease. 2020. doi:10.1101/2020.08.09.20171330
30. Aiyegbusi OL, Hughes SE, Turner G, et al. Symptoms, complications and management of long COVID: a review. J R Soc Med. 2021; 114:428–442
31. Batalik L, Konecny V, Dosbaba F, et al. Cardiac rehabilitation based on the walking test and telerehabilitation improved cardiorespiratory fitness in people diagnosed with coronary heart disease during the covid-19 pandemic. J Environmental Research and Public Health. 2021; 18:1–11. doi:10.3390/ijerph18052241
32. Ma L, Xiong X, Yan L, et al. Home-based exercise is associated with improved cardiac functional performance in patients after acute myocardial infarction. J Int Med Research. 2020; 48. doi:10.1177/0300060520977637
33. Thamman R, Janardhanan R. Cardiac rehabilitation using telemedicine: the need for tele cardiac rehabilitation. J Cardiovascular Med. 2020; 21:497–500. doi:10.31083/j.rcm.2020.04.201
34. Cavalheiro AH, Silva Cardoso J, Rocha A, et al. Effectiveness of Telerehabilitation Programs in Heart Failure: A Systematic Review and Meta-analysis. J Health Services Insights. 2021; 14. doi: 10.1177/11786329211021668
35. Scherrenberg M, Wilhelm M, Hansen D, et al. The future is now: A call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology. J European of Preventive Cardiology. 2021; 28:524–540. doi:10.1177/2047487320939671
36. Kato M, Ono S, Seko H, et al. Trajectories of frailty, physical function, and physical activity levels in elderly patients with heart failure: Impacts of interruption and resumption of outpatient cardiac rehabilitation due to COVID-19. J International of Rehabilitation Research. 2021 doi:10.1097/MRR.0000000000000473
37. Moulson N, Bewick D, Selway T, et al. Cardiac Rehabilitation During the COVID-19 Era: Guidance on Implementing Virtual Care. J Canadian of Cardiology. 2020; 36:1317–1321. doi:10.1016/j.cjca.2020.06.006
38. Nan J, Jia R, Meng S, et al. The Impact of the COVID-19 Pandemic and the Importance of Telemedicine in Managing Acute ST Segment Elevation Myocardial Infarction Patients: Preliminary Experience and Literature Review. J Med Syst. 2021; 45(9). doi:10.1007/s10916-020-01703-6/Published
39. Beleigoli A, Champion S, Tirimacco R, et al. A co-designed telehealth-based model of care to improve attendance and completion to cardiac rehabilitation of rural and remote Australians: The Country Heart Attack Prevention (CHAP) project. J Telemedicine and Telecare. 2021; 27:685–690. doi:10.1177/1357633X211048400
40. Scott-Sheldon LAJ, Gathright EC, Wu W-C. Promoting Social Connectedness among Cardiac Rehabilitation Patients During the COVID-19 Pandemic and Beyond. R I Med J. 2013; 103(9):34-35
41. Scherrenberg M, Falter M, Dendale P. Patient experiences and willingness-to-pay for cardiac telerehabilitation during the first surge of the COVID-19 pandemic: single-centre experience. Acta Cardiol. 2021; 76(2):151–157. doi:10.1080/00015385.2020.1846920
42. de Melo Ghisi GL, Xu Z, Liu X, et al. Impacts of the COVID-19 Pandemic on Cardiac Rehabilitation Delivery around the World. Glob Heart J. 2020; 16(1):43. doi:10.5334/gh.939
43. Jaiswal V, Nagpal S, Labitag CAE, et al. A Systematic Review of COVID-19 Induced Myocarditis-Symptomatology, Prognosis, and Clinical Findings. 2021 doi:10.1101/2021.05.29.21258059