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Hastings-Truelove A, Ghahari S, Coderre-Ball A, Kessler D, Turnnidge J, Lester B, Auais M, Dalgarno N, DePaul V, Donnelly C, Finlayson M, Hopkins-Rosseel D, Kolomitro K, Norman K, Lawson TL, Stockley D, Van Wylick R, Woo K. Barriers and facilitators to older adults’ engagement in healthy aging initiatives. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Disparities in Cardiac Rehabilitation Participation in the United States: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Cardiopulm Rehabil Prev 2017; 37:2-10. [PMID: 27676464 DOI: 10.1097/hcr.0000000000000203] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Phase 2 cardiac rehabilitation (CR) is a class I recommendation for all patients following an acute cardiac event or cardiac surgery according to the The American Heart Association and the American College of Cardiology Foundation. Studies have shown that there are differences in cardiac rehabilitation participation rates between sociodemographic groups. The purpose of this systematic review and meta-analyses was to synthesize quantitative data on the relationship between outpatient cardiac rehabilitation (OCR) attendance and various sociodemographic factors. METHODS We conducted a search of PubMed, PsycINFO, CINAHL, Google Scholar, Dissertations & Theses A&I, and conference abstracts for observational studies conducted in the United States that fit our inclusion criteria. A total of 21 studies were included in our final review and meta-analyses. RESULTS Our meta-analyses showed that overall, attenders were younger than nonattenders (mean difference=-3.74 years, 95% CI =-5.87 to -1.61) and the odds of participation were lower among females (OR = 0.59; 95% CI = 0.51-0.69), individuals with a high school degree or less (OR = 0.67; 95% CI = 0.50-0.91), and the uninsured or self-payers (OR = 0.32; 95% CI = 0.14-0.71). Full- or part-time employees were more likely to participate than those not employed (OR = 1.45; 95% CI = 1.08-1.95). CONCLUSIONS Our systematic review and meta-analyses showed that there are significant sociodemographic disparities in CR participation. On the basis of this knowledge, clinicians and policy makers should focus on identifying and eliminating barriers to participation.
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Resurrección DM, Motrico E, Rigabert A, Rubio-Valera M, Conejo-Cerón S, Pastor L, Moreno-Peral P. Barriers for Nonparticipation and Dropout of Women in Cardiac Rehabilitation Programs: A Systematic Review. J Womens Health (Larchmt) 2017; 26:849-859. [PMID: 28388314 DOI: 10.1089/jwh.2016.6249] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major health problem worldwide. Cardiac rehabilitation (CR) programs are effective in reducing mortality and improving the quality of life of patients with CVD. Women are under-represented in CR and have a higher dropout rate than men. We aimed to systematically review the literature on barriers perceived by women with CVD affecting their nonparticipation in and/or dropping out from CR programs. METHODS Systematic review was done using MEDLINE, Embase, Scopus, Open Grey, and Cochrane Database from inception to September 2016. Search terms included (1) heart disease and other cardiac conditions, (2) CR and secondary prevention, and (3) nonparticipation in and/or dropout. Databases were searched following the "participants, interventions, comparisons, outcomes, and study design" method. RESULTS A total of 24 studies (17 descriptive, 6 qualitative, and 1 randomized controlled trial) reporting several barriers were grouped into five broad categories: intrapersonal barriers (self-reported health, health beliefs, lack of time, motivation, and religious reasons); interpersonal barriers (lack of family/social support and work conflicts); logistical barriers (transport, distance, and availability of personal/community resources); CR program barriers (services offered, group format, exercise component, and CR sessions); and health system barriers (lack of referral, cost, negative experiences with the health system, and language). We found differences between the barriers related to nonparticipation in and dropout from CR programs. CONCLUSIONS Women reported multilevel barriers for nonparticipation in and dropout from CR programs. Future clinical guidelines should evaluate and eliminate these barriers to improve adherence to CR programs in women. In addition, understanding the barriers for nonparticipation and dropout may be beneficial for future intervention trials.
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Affiliation(s)
| | - Emma Motrico
- 1 Departamento de Psicología, Universidad Loyola Andalucía , Sevilla, Spain .,2 Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Barcelona, Spain
| | - Alina Rigabert
- 1 Departamento de Psicología, Universidad Loyola Andalucía , Sevilla, Spain
| | - Maria Rubio-Valera
- 2 Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Barcelona, Spain .,3 Research and Development Unit , Fundació Sant Joan de Déu, Barcelona, Spain
| | - Sonia Conejo-Cerón
- 4 Instituto de Investigación Biomédica de Málaga (IBIMA) , Málaga, Spain
| | - Luis Pastor
- 5 Hospital Nuestra Señora de Valme , Sevilla, Spain
| | - Patricia Moreno-Peral
- 2 Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Barcelona, Spain .,4 Instituto de Investigación Biomédica de Málaga (IBIMA) , Málaga, Spain
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Pourhabib S, Kentner AC, Grace SL. The impact of patient-healthcare provider discussions on enrollment in cardiovascular rehabilitation. J Rehabil Med 2014; 46:924-31. [PMID: 25102939 PMCID: PMC4527842 DOI: 10.2340/16501977-1852] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Secondary prevention programs such as cardiovascular rehabilitation significantly decrease the burden of cardiovascular disease, yet are under-used. The most successful strategy to promote cardiovascular rehabilitation utilization is systematic referral with a patient-provider discussion. This study investigated: (i) the elements of patient-provider discussions related to patient cardiovascular rehabilitation enrollment, and (ii) the frequency and correlates of these discussion elements. DESIGN/PARTICIPANTS This was a prospective study of cardiovascular patients and their healthcare providers. Discussions about "secondary prevention" were audio-recorded. Utterances were coded using the Roter Interaction Analysis System. Two months later, cardiovascular rehabilitation enrollment was ascertained. RESULTS Discussions between 26 healthcare providers and 50 patients were recorded, of whom 27 (54.0%) enrolled in cardiovascular rehabilitation. Participants were significantly more likely to enroll in cardiovascular rehabilitation when their healthcare providers offered less reassurance and optimism (odds ratio (OR) = 0.81), and when the patient asked more questions related to lifestyle (OR = 4.98). These were not common. CONCLUSION While caution is warranted due to the number of comparisons undertaken such that associations observed may be chance associations, these novel findings suggest that not overstating the beneficial effects of acute treatment, and allowing patients more time to ask questions about needed lifestyle changes should be investigated in future research.
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Affiliation(s)
| | | | - Sherry L. Grace
- York University, Toronto, Canada
- University Health Network, Toronto, Canada
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Shanmugasegaram S, Oh P, Reid RD, McCumber T, Grace SL. Cardiac rehabilitation barriers by rurality and socioeconomic status: a cross-sectional study. Int J Equity Health 2013; 12:72. [PMID: 23985017 PMCID: PMC3765803 DOI: 10.1186/1475-9276-12-72] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 08/23/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Despite greater need, rural inhabitants and individuals of low socioeconomic status (SES) are less likely to undertake cardiac rehabilitation (CR). This study examined barriers to enrollment and participation in CR among these under-represented groups. METHOD Cardiac inpatients from 11 hospitals across Ontario were approached to participate in a larger study. Rurality was assessed by asking participants whether they lived within a 30-minute drive-time from the nearest hospital, with those >30 minutes considered "rural." Participants completed a sociodemographic survey, which included the MacArthur Scale of Subjective Social Status. One year later, they were mailed a survey which assessed CR utilization and included the Cardiac Rehabilitation Barriers Scale. In this cross-sectional study, CR utilization and barriers were compared by rurality and SES. RESULTS Of the 1809 (80.4%) retained, there were 215 (11.9%) rural participants, and the mean subjective SES was 6.37 ± 1.76. The mean CRBS score was 2.03 ± 0.73. Rural inhabitants reported attending significantly fewer CR sessions (p < .05), and greater CR barriers overall compared to urban inhabitants (p < .01). Patients of lower subjective SES were significantly less likely to be referred, enroll, and participate in CR, and reported significantly greater barriers to CR compared to their high SES counterparts (p < .01). Prominent barriers for both groups included distance, cost, and transportation problems. These relationships sustained adjustment, and a significant relationship between having undergone coronary artery bypass graft surgery and lower barriers was also identified. CONCLUSIONS The results confirm that rural inhabitants and patients of low SES experience greater barriers to CR utilization when compared to their urban, high SES counterparts. It is time to implement known strategies to overcome these barriers, to achieve equitable and greater use of CR.
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Affiliation(s)
| | - Paul Oh
- University Health Network - Toronto Rehabilitation Institute, Toronto, Canada
| | - Robert D Reid
- University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Sherry L Grace
- York University and University Health Network, Toronto, Canada
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Sangster J, Furber S, Phongsavan P, Allman-Farinelli M, Redfern J, Bauman A. Where you live matters: Challenges and opportunities to address the urban-rural divide through innovative secondary cardiac rehabilitation programs. Aust J Rural Health 2013; 21:170-7. [DOI: 10.1111/ajr.12031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2013] [Indexed: 01/05/2023] Open
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Ghisi GLM, Polyzotis P, Oh P, Pakosh M, Grace SL. Physician factors affecting cardiac rehabilitation referral and patient enrollment: a systematic review. Clin Cardiol 2013; 36:323-35. [PMID: 23640785 PMCID: PMC3736151 DOI: 10.1002/clc.22126] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 03/17/2013] [Indexed: 12/28/2022] Open
Abstract
Physicians play an important role in CR referral and enrollment. Despite established benefits and recommendations, cardiac rehabilitation (CR) enrollment rates are pervasively low. The reasons cardiac patients are missing from CR programs are multifactorial and include provider factors. A number of studies have now investigated physician factors associated with referral to CR programs and patient enrollment. The objective of this study was to qualitatively and systematically review this literature. A literature search of MEDLINE, PsycINFO, CINAHL, Embase, and EBM was conducted for published articles from database inception to October 2011. Overall, 17 articles were included following a process of independent review of each article by 2 authors. Seven (41.2%) were graded as good quality according to Downs and Black criteria. There were no randomized controlled trials. Results showed that medical specialty (ie, cardiac specialists more likely to refer; n = 8 studies) and other physician-reported reasons (eg, physician report of their reasons for CR referral and physician sex) were related to referral. Physician factors related to patient enrollment in CR were physician endorsement, medical specialty, being referred, and physician attitudes toward CR. Physician factors are consistently related to CR referral and enrollment. The role of physician endorsements in promoting patient enrollment should be optimized and exploited.
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Affiliation(s)
- Gabriela L M Ghisi
- Exercise Sciences Department, Faculty of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
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The role of clinical and geographic factors in the use of hospital versus home-based cardiac rehabilitation. Int J Rehabil Res 2012; 35:220-6. [PMID: 22561240 DOI: 10.1097/mrr.0b013e328353e375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cardiac rehabilitation (CR) is most often provided in a hospital setting. Home-based models of care have been developed to overcome geographic, among other, barriers in patients at a lower risk. This study assessed whether clinical and geographic factors were related to the use of either a hospital-based or a home-based program. Secondary analysis was undertaken within a study of 1268 cardiac outpatients recruited from 97 cardiologist practices where clinical data were extracted. Participants completed a survey including the Duke Activity Status Index. They reported CR utilization in a second survey mailed 9 months later, including CR site and program model. Geographic information systems were used to determine the distances and the drive times to the CR site attended from patients' homes. Overall, 469 (37.0%) participants attended CR at one of 41 programs. Of the 373 (79.5%) participants with complete geographic data, 43 (11.5%) reported attending home-based CR. The sole clinical difference was in activity status, where patients attending a hospital-based program had lower activity status (P<0.01). There were no differences in model attended on the basis of geographic parameters including urban versus rural dwelling or drive times (P>0.05). In conclusion, only one-tenth of outpatients participated in a home-based program, and this allocation was unrelated to geographic considerations. Although patients should continue to be appropriately triaged on the basis of clinical risk to ensure safety, more targeted allocation of patients to home-based services may be warranted. This may optimize the degree of participation and potentially patient outcomes.
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Bestehorn K, Jannowitz C, Horack M, Karmann B, Halle M, Völler H. Current state of cardiac rehabilitation in Germany: patient characteristics, risk factor management and control status, by education level. Vasc Health Risk Manag 2011; 7:639-47. [PMID: 22140313 PMCID: PMC3225345 DOI: 10.2147/vhrm.s22971] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background After the acute hospital stay, most cardiac patients in Germany are transferred for a 3–4-week period of inpatient cardiac rehabilitation. We aim to describe patient characteristics and risk factor management of cardiac rehabilitation patients with a focus on drug treatment and control status, differentiated by education level (low level, elementary school; intermediate level, secondary modern school; high level, grammar school/university). Methods Data covering a time period between 2003 and 2008 from 68,191 hospitalized patients in cardiac rehabilitation from a large-scale registry (Transparency Registry to Objectify Guideline- Oriented Risk Factor Management) were analyzed descriptively. Further, a multivariate model was applied to assess factors associated with good control of risk factors. Results In the total cohort, patients with a manifestation of coronary artery disease (mean age 63.7 years, males 71.7%) were referred to cardiac rehabilitation after having received percutaneous coronary intervention (51.6%) or coronary bypass surgery (39.5%). Statin therapy increased from 76.3% at entry to 88.9% at discharge, and low density lipoprotein cholesterol < 100 mg/dL rates increased from 31.1% to 69.6%. Mean fasting blood glucose decreased from 108 mg/dL to 104 mg/dL, and mean exercise capacity increased from 78 W to 95 W. Age and gender did not differ by education. In contrast with patients having high education, those with low education had more diabetes, hypertension, and peripheral arterial disease, had lower exercise capacity, and received less treatment with statins and guideline-orientated therapy in general. In the multivariate model, good control was significantly more likely in men (odds ratio 1.38; 95% confidence interval 1.30–1.46), less likely in patients of higher age (0.99; 0.99–0.99), with diabetes (0.90; 0.85–0.95), or peripheral arterial disease (0.88; 0.82–0.95). Compared with a low level education, a mid level education was associated with poor control (0.94; 0.89–0.99), while high education did not have a significant effect (1.08; 0.99–1.17). Conclusion Patients with different levels of education treated in cardiac rehabilitation did not differ relevantly in terms of demographics, but did differ in some clinical aspects. With respect to the ultimate goal of cardiac rehabilitation, ie, optimal control of risk factors, education level does not play an important role.
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Affiliation(s)
- Kurt Bestehorn
- Institute for Clinical Pharmacology, Technical University, Dresden, Germany.
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Leung YW, Brual J, Macpherson A, Grace SL. Geographic issues in cardiac rehabilitation utilization: a narrative review. Health Place 2010; 16:1196-205. [PMID: 20724208 DOI: 10.1016/j.healthplace.2010.08.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/27/2010] [Accepted: 08/04/2010] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study was to review the current evidence regarding the relationship between geographic indicators and cardiac rehabilitation (CR) utilization among coronary heart disease (CHD) patients. RESULTS Seventeen articles were identified for inclusion, where nine studies assessed rurality, 10 studies assessed travel time/distance, and two of these studies assessed both. Nine of the 17 studies (52.9%) showed a significant negative relationship between geographic barrier and CR use. Four of the 17 studies (23.5%) showed a null relationship, while four studies (23.5%) showed mixed findings. Inconsistent findings identified appeared to be related to restricted geographic range, regional density, and socioeconomic status. CONCLUSIONS Overall, 52.9% of the identified studies reported a significant negative relationship between geographic indicators and CR utilization. This relationship appeared to be particularly consistent in North American and Australian settings, but somewhat less so in the United Kingdom where there is greater population density and availability of public transport.
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Affiliation(s)
- Yvonne W Leung
- School of Kinesiology and Health Science, York University, Toronto, Canada
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Brual J, Gravely-Witte S, Suskin N, Stewart DE, Macpherson A, Grace SL. Drive time to cardiac rehabilitation: at what point does it affect utilization? Int J Health Geogr 2010; 9:27. [PMID: 20525345 PMCID: PMC2900239 DOI: 10.1186/1476-072x-9-27] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 06/04/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A 30 minute drive time threshold has often been cited as indicative of accessible health services. Cardiac rehabilitation (CR) is a chronic disease management program designed to enhance and maintain cardiovascular health, and geographic barriers to utilization are often cited. The purpose of this study was to empirically test the drive time threshold for CR utilization. METHODS A prospective study, using a multi-level design of coronary artery disease outpatients nested within 97 cardiologists. Participants completed a baseline sociodemographic survey, and reported CR referral, enrollment and participation in a second survey 9 months later. CR utilization was verified with CR sites. Geographic information systems were used to generate drive times at 60, 80 and 100% of the speed limit to the closest CR site from participants' homes, to take into consideration various traffic conditions. Bivariate analysis was used to test for differences in CR referral, enrollment and degree of participation by drive time. Logistic regression was used to test drive time increments where significant differences were found. RESULTS Drive times were generated for 1209 outpatients. Overall, CR referral was verified for 523 (43.3%) outpatients, with verified enrollment for 444 (36.7%) participating in a mean of 86.4 +/- 25.7% of prescribed sessions. There were significant differences in CR referral and enrollment by drive time (ps < .01), but not degree of participation. Logistic regression analysis (ps < .001) revealed that the drive time threshold at 80% of the posted speed limit for physician referral may be 60 minutes (OR = .26, 95% CI: 0.13-0.55), and the threshold for patient CR enrollment may also be 60 minutes (OR = .11, 95% CI: 0.04-0.33). CONCLUSIONS Physicians may be taking geography into consideration when referring patients to CR. Empirical consideration also reveals that patients are significantly less likely to enroll in CR where they must drive 60 minutes or more to the closest program. Once enrolled, distance has no significant effect on degree of participation.
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Affiliation(s)
- Janette Brual
- Department of Geography, Queen's University, 99 University Avenue, Kingston, Ontario, K7L 3N6, Canada
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Sangster J, Furber S, Allman-Farinelli M, Haas M, Phongsavan P, Mark A, Bauman A. A population-based lifestyle intervention to promote healthy weight and physical activity in people with cardiac disease: the PANACHE (Physical Activity, Nutrition And Cardiac HEalth) study protocol. BMC Cardiovasc Disord 2010; 10:17. [PMID: 20374661 PMCID: PMC2858099 DOI: 10.1186/1471-2261-10-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 04/08/2010] [Indexed: 11/13/2022] Open
Abstract
Background Maintaining a healthy weight and undertaking regular physical activity are important for the secondary prevention of cardiovascular disease (CVD). However, many people with CVD are overweight and insufficiently active. In addition, in Australia only 20-30% of people requiring cardiac rehabilitation (CR) for CVD actually attend. To improve outcomes of and access to CR the efficacy, effectiveness and cost-effectiveness of alternative approaches to CR need to be established. This research will determine the efficacy of a telephone-delivered lifestyle intervention, promoting healthy weight and physical activity, in people with CVD in urban and rural settings. The control group will also act as a replication study of a previously proven physical activity intervention, to establish whether those findings can be repeated in different urban and rural locations. The cost-effectiveness and acceptability of the intervention to CR staff and participants will also be determined. Methods/Design This study is a randomised controlled trial. People referred for CR at two urban and two rural Australian hospitals will be invited to participate. The intervention (healthy weight) group will participate in four telephone delivered behavioural coaching and goal setting sessions over eight weeks. The coaching sessions will be on weight, nutrition and physical activity and will be supported by written materials, a pedometer and two follow-up booster telephone calls. The control (physical activity) group will participate in a six week intervention previously shown to increase physical activity, consisting of two telephone delivered behavioural coaching and goal setting sessions on physical activity, supported by written materials, a pedometer and two booster phone calls. Data will be collected at baseline, eight weeks and eight months for the intervention group (baseline, six weeks and six months for the control group). The primary outcome is weight change. Secondary outcomes include physical activity, sedentary time and nutrition habits. Costs will be compared with outcomes to determine the relative cost-effectiveness of the healthy weight and physical activity interventions. Discussion This study addresses a significant gap in public health practice by providing evidence for the efficacy and cost-effectiveness of a low cost, low contact, high reach intervention promoting healthy weight and physical activity among people with CVD in rural and urban areas in Australia. The replication arm of the study, undertaken by the control group, will demonstrate whether the findings of the previously proven physical activity intervention can be generalised to new settings. This population-based approach could potentially improve access to and outcomes of secondary prevention programs, particularly for rural or disadvantaged communities. Trial Registration ACTRN12610000102077
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Affiliation(s)
- Janice Sangster
- Health Promotion Service, South Eastern Sydney and Illawarra Area Health, NSW, Australia.
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White S, Anderson C. The involvement of pharmacists in cardiac rehabilitation: a review of the literature. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/0022357055984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
To identify, review and evaluate the literature regarding the role of the pharmacist in cardiac rehabilitation (CR).
Method
Electronic databases searched up to October 2004 were Medline, Pharmline, Iowa Drug Information service, International Pharmacy Abstracts, Embase, Scanners and Web of Science. Reference lists of identified papers were searched and a Zetoc email alert was created to identify additional papers. Papers were included only if they referred specifically to a CR programme or CR patients, and also referred to the involvement of pharmacists or concerned pharmacy practice research. Reports were not excluded on the basis of quality, however reports that met the criteria for inclusion were allocated an evidence grade to indicate quality.
Key findings
Thirteen reports were identified, of which six reports were purely descriptive accounts of pharmacists' involvement in CR (all were from the US) and seven were evaluative reports (four from the US, two from the UK and one from Canada). Descriptions of the involvement of pharmacists in CR included providing medicines information and education to patients, and optimising drug therapy. The lack of substantial research was notable among the evaluative reports. One study found quality of life and economic benefits as a result of the involvement of a pharmacist in CR, and another found that health professionals provide most of the medicines information and education required by CR patients. However these studies were weakened by a lack of meaningful outcome measures.
Conclusion
There is insufficient evidence on which to base firm conclusions about the effectiveness of the involvement of pharmacists in CR. This has implications for pharmacy practitioners, researchers and policymakers in CR.
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Affiliation(s)
- Simon White
- Centre for Pharmacy, Health and Society, School of Pharmacy, University of Nottingham, UK
- United Lincolnshire Hospitals NHS Trust, Pilgrim Hospital, Boston, UK
| | - Claire Anderson
- Centre for Pharmacy, Health and Society, School of Pharmacy, University of Nottingham, UK
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Correlates of exercise among coronary heart disease patients: review, implications and future directions. ACTA ACUST UNITED AC 2009; 16:515-26. [DOI: 10.1097/hjr.0b013e3283299585] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Relationship between cardiac rehabilitation and survival after acute cardiac hospitalization within a universal health care system. ACTA ACUST UNITED AC 2009; 16:102-13. [PMID: 19165089 DOI: 10.1097/hjr.0b013e328325d662] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The magnitude and mechanisms of survival benefit associated with cardiac rehabilitation services among real-world populations within a universal health care system remain unclear. METHODS This retrospective matched cohort study compared the long-term survival of 2042 cardiac rehabilitation participants with 2042 matched controls after an index acute cardiac hospitalization between 1999 and 2003, in Ontario, Canada. Each patient survived at least 1 year without recurrent admissions after discharge from the index hospitalization, and was followed for a mean of 5.25 years. Additional matching criteria included the type of sentinel cardiac events, age, sex, socioeconomic status, geography, previous cardiac and noncardiac hospitalizations. A Cox proportional hazards model further adjusted for baseline cardiovascular risk factors and process factors, cardiovascular risk-factor progression, downstream coronary procedure and evidence-based pharmacotherapy utilization. RESULTS Cardiac rehabilitation participation was associated with a 50% lower mortality rate (2.6 vs. 5.1%, P<0.001) as compared with population-matched controls. Statistically significant mortality benefits were observed among high-risk patients, and there was no significant interaction among age, cardiac rehabilitation participation, and survival (P=0.22). Associated survival advantages were not meaningfully altered after adjustment for cardiovascular risk-factor progression or the downstream utilization rates of cardiac procedures and evidence-based cardiovascular therapies; survival benefits predominantly applied to those patients that were most compliant with the program. CONCLUSION Cardiac rehabilitation is associated with significant long-term survival advantages after index cardiovascular hospitalizations. Despite universal access to medical care, such survival advantages seem to be mediated by compliant behaviors more so than by ancillary health service or evidence-based pharmacotherapy utilization.
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Abstract
BACKGROUND Marital status has been clearly linked to subsequent health outcomes in those with established coronary heart disease (CHD). This robust association may be because of both pathophysiological and behavioural mechanisms. DESIGN We employed meta-regression to examine the association between marital status and attendance at outpatient cardiac rehabilitation (CR) in published studies. METHODS We searched electronic databases, for example, Medline and Science Citation Index, for published studies that reported an association between a measure of marital or partnered status and CR attendance in patients with diagnosed CHD. RESULTS Eleven studies were identified which incorporated 6,984 CHD patients. Being married/partnered was associated with significantly higher odds of attending CR. Using a fixed effects model, the pooled odds ratio of CR attendance was 1.72 [95% confidence interval (CI) 1.50-1.97] for those who were married/partnered. There was no evidence of heterogeneity of effects (P=0.42) or publication bias (P=0.12). CONCLUSION CHD patients who are married or have a partner are between 1.5-2 times more likely to attend CR. Associations between marital status and CR attendance may partly explain CHD outcomes.
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Are there meaningful longitudinal changes in health related quality of life--SF36, in cardiac rehabilitation patients? Eur J Cardiovasc Nurs 2008; 8:40-7. [PMID: 18504159 DOI: 10.1016/j.ejcnurse.2008.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 02/15/2008] [Accepted: 04/15/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aimed to observe changes in quality of life and minimal clinical important differences of quality of life over time in cardiac rehabilitation patients and to compare these with published normal data. METHODS In this non-randomised study, SF36 questionnaires were completed by 187 patients recruited to a Phase III cardiac rehabilitation multidisciplinary outpatient programme. Data was collected at beginning, end and six months after Phase III cardiac rehabilitation programme. RESULTS There were significant improvements in physical functioning, role limitation due to physical function, pain and general health perception scales, over the above time frame, from both a statistically and a mean clinical important difference point of view. These improvements occurred mainly during the cardiac rehabilitation programme phase. CONCLUSIONS These improvements meant that patients six months post-cardiac rehabilitation were only 5% below the quality of life for an aged matched normal group. However patients still had significant deficits in physical role and emotional role limitations. Suitable measurement of quality of life on an individual basis, supported by normal values is needed. This would facilitate the identification of shortfalls in patient quality of life and the subsequent tailoring of care to address these individualised patient needs.
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Harkness K, Smith KM, Taraba L, Mackenzie CL, Gunn E, Arthur HM. Effect of a postoperative telephone intervention on attendance at intake for cardiac rehabilitation after coronary artery bypass graft surgery. Heart Lung 2005; 34:179-86. [PMID: 16015222 DOI: 10.1016/j.hrtlng.2004.07.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Enrollment in cardiac rehabilitation (CR) after coronary artery bypass graft (CABG) surgery is suboptimal (25%-30%). OBJECTIVES The purpose of this study was to examine the effect of a nurse-initiated telephone call (NIC) on attendance at a CR intake appointment. METHODS By using a retrospective cohort design, data were collected on 3536 patients who underwent CABG between April 1996 and March 2000 and were referred to CR. Of these, 2285 patients received standard care (no NIC) and 1251 received the NIC. RESULTS Patients who received the NIC were significantly more likely to attend their CR intake appointment compared with standard care (78.1% vs. 50.1%; P < .0001). Hierarchic logistic regression analysis revealed the NIC as the strongest predictor of attendance at a CR intake explaining 56.9% of the total variance (odds ratio =3.429; 95% confidence interval = 2.919-4.028; P < .0001). CONCLUSION These findings suggest that pre-appointment telephone contact by a cardiovascular nurse is a valuable tool to enhance attendance at a CR intake appointment after CABG.
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Jackson L, Leclerc J, Erskine Y, Linden W. Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors. Heart 2005; 91:10-4. [PMID: 15604322 PMCID: PMC1768637 DOI: 10.1136/hrt.2004.045559] [Citation(s) in RCA: 263] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2004] [Indexed: 11/04/2022] Open
Abstract
Comprehensive cardiac rehabilitation reduces mortality and morbidity but is utilised by only a fraction of eligible cardiac patients, with the participation rate of women being only about half that of men. This quantitative review assesses 32 studies meeting inclusion criteria, describing 16,804 patients, 5882 of whom were female. It was found that the main predictor of referral to a cardiac rehabilitation programme was the physician's endorsement of the effectiveness of such a programme. Patients were more likely to participate in rehabilitation programmes when they were actively referred, educated, married, possessed high self efficacy, and when the programmes were easily accessible. Patients were less likely to participate when they had to travel long distances to participate in a cardiac rehabilitation programme, or experienced guilt over family obligations. Women were less often referred and participated less often even after referral. In conclusion, many of the observed predictors, including those particular to women, are potentially modifiable with the help of health professionals.
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Affiliation(s)
- L Jackson
- University of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Nursing research has contributed to our knowledge of patients with coronary heart disease (CHD), although much of the research has focused on acute cardiac events. Active and ongoing programs of research into CHD patient outcomes are essential as significant gaps remain. Consistently effective strategies to help patients change risk behaviors, recognize salient symptoms, manage their CHD and ischemic symptoms, improve function and quality of life, and prevent subsequent coronary events are needed, especially in the elderly and those with multiple comorbidities.
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Affiliation(s)
- Christi Deaton
- School of Nursing, Midwifery and Health Visiting, University of Manchester, Manchester, United Kingdom.
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Strine TW, Greenlund KJ, Brown DW, Mokdad A, Balluz L. Characteristics of people aged 45 years or older with heart disease by frequent mental distress status, 2001. Prev Med 2004; 39:191-6. [PMID: 15208002 DOI: 10.1016/j.ypmed.2004.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Depression commonly occurs after nonfatal cardiac events and is associated with adverse health outcomes. METHODS In 2001, the Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit-dialed telephone survey of non-institutionalized adults, administered cardiovascular health questions to 19 states and DC. Among those aged > or = 45 years, we examined the association of frequent mental distress (FMD) (> or = 14 self-reported mentally unhealthy days in the past 30 days) with modifiable adverse behaviors (smoking, physical inactivity, and obesity) and health care coverage. RESULTS The prevalence of FMD among adults with heart disease was 14.8%. Age-adjusted odds ratios indicated that adults with heart disease and FMD were more likely to smoke, to be physically inactive, to be obese, and to be without health care coverage than persons without FMD. Although frequent mental distress was associated with only one adverse health behavior (physical inactivity) after fully adjusting when these health behaviors were considered separately, we observed a twofold increased likelihood for the presence of multiple adverse health behaviors among those with FMD as compared to those without FMD. CONCLUSIONS Medical counseling on lifestyle changes after cardiac events is accepted as a key part of rehabilitation; however, the mental well-being of patients may also need to be monitored, as it may be a mediating factor in achieving healthy lifestyle goals.
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Affiliation(s)
- Tara W Strine
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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