1
|
Thompson MP, Hou H, Fliegner M, Guduguntla V, Cascino T, Aaronson KD, Likosky DS, Sukul D, Keteyian SJ. Cardiac Rehabilitation Use After Heart Failure Hospitalization Associated With Advanced Heart Failure Center Status. J Cardiopulm Rehabil Prev 2024; 44:194-201. [PMID: 38300252 PMCID: PMC11065630 DOI: 10.1097/hcr.0000000000000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE Cardiac rehabilitation (CR) is an evidence-based, guideline-endorsed therapy for patients with heart failure with reduced ejection fraction (HFrEF) but is broadly underutilized. Identifying structural factors contributing to increased CR use may inform quality improvement efforts. The objective here was to associate hospitalization at a center providing advanced heart failure (HF) therapies and subsequent CR participation among patients with HFrEF. METHODS A retrospective analysis was performed on a 20% sample of Medicare beneficiaries primarily hospitalized with an HFrEF diagnosis between January 2008 and December 2018. Outpatient claims were used to identify CR use (no/yes), days to first session, number of attended sessions, and completion of 36 sessions. The association between advanced HF status (hospitals performing heart transplantation or ventricular assist device implantations) and CR participation was evaluated with logistic regression, accounting for patient, hospital, and regional factors. RESULTS Among 143 392 Medicare beneficiaries, 29 487 (20.6%) were admitted to advanced HF centers (HFCs) and 5317 (3.7%) attended a single CR session within 1 yr of discharge. In multivariable analysis, advanced HFC status was associated with significantly greater relative odds of participating in CR (OR = 2.20: 95% CI, 2.08-2.33; P < .001) and earlier initiation of CR participation (-8.5 d; 95% CI, -12.6 to 4.4; P < .001). Advanced HFC status had little to no association with the intensity of CR participation (number of visits or 36 visit completion). CONCLUSIONS Medicare beneficiaries hospitalized for HF were more likely to attend CR after discharge if admitted to an advanced HFC than a nonadvanced HFC.
Collapse
Affiliation(s)
- Michael P. Thompson
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Max Fliegner
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA
| | - Vinay Guduguntla
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Thomas Cascino
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Keith D. Aaronson
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Donald S. Likosky
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Steven J. Keteyian
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
2
|
Ferrel-Yui D, Candelaria D, Pettersen TR, Gallagher R, Shi W. Uptake and implementation of cardiac telerehabilitation: A systematic review of provider and system barriers and enablers. Int J Med Inform 2024; 184:105346. [PMID: 38281451 DOI: 10.1016/j.ijmedinf.2024.105346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/20/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Cardiac telerehabilitation has demonstrated effectiveness for patient health outcomes, but uptake and implementation into practice have been limited and variable. While patient-level influences on uptake have been identified, little is known about provider- and system-level factors. AIMS To identify provider and system barriers and enablers to uptake and implementation of cardiac telerehabilitation. METHODS A systematic review was conducted, including a search of six databases (MEDLINE, Embase, CINAHL, Scopus, Web of Science, and PsycINFO) from 2000 to March 2023. Two reviewers independently screened eligible articles. Study quality was evaluated according to study design by the Critical Appraisal Skills Programme (CASP) checklist for qualitative data, the Appraisal Tool for Cross-sectional Studies (AXIS), and the Mixed Methods Appraisal Tool (MMAT) for mixed methods. Data were analysed using narrative synthesis. RESULTS Twenty eligible studies (total 1674 participants) were included. Perceived provider-level barriers included that cardiac telerehabilitation is resource intensive, inferior to centre-based delivery, and lack of staff preparation. Whereas provider-level enablers were having access to resources, adequate staff preparation, positive staff beliefs regarding cardiac telerehabilitation and positive team dynamics. System-level barriers related to unaligned policy, healthcare system and insurance structures, technology issues, lack of plans for implementation, and inadequate resources. System-level enablers included cost-effectiveness, technology availability, reliability, and adaptability, and adequate program development, implementation planning and leadership support. CONCLUSIONS Barriers and enablers at both provider and system levels must be recognised and addressed at the local context to ensure better uptake of cardiac telerehabilitation programs.
Collapse
Affiliation(s)
- Daniel Ferrel-Yui
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, D18, Western Avenue, Camperdown, New South Wales 2050, Australia
| | - Dion Candelaria
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, D18, Western Avenue, Camperdown, New South Wales 2050, Australia; The University of Sydney, Charles Perkins Centre, D17, John Hopkins Drive, Camperdown, New South Wales, 2050, Australia.
| | - Trond Røed Pettersen
- Haukeland University Hospital, Department of Heart Disease, Box 1400, 5021, Bergen, Norway
| | - Robyn Gallagher
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, D18, Western Avenue, Camperdown, New South Wales 2050, Australia; The University of Sydney, Charles Perkins Centre, D17, John Hopkins Drive, Camperdown, New South Wales, 2050, Australia
| | - Wendan Shi
- The University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, D18, Western Avenue, Camperdown, New South Wales 2050, Australia; The University of Sydney, Charles Perkins Centre, D17, John Hopkins Drive, Camperdown, New South Wales, 2050, Australia; St George Hospital, Centre for Research in Nursing and Health, Gray Street, Kogarah, New South Wales 2217, Australia
| |
Collapse
|
3
|
Aldhahir AM, Alhotye M, Alqahtani JS, Alghamdi SM, Alsulayyim AS, Alqarni AA, Alzahrani EM, Siraj RA, Alwafi H. Physicians' Perceptions of and Barriers to Cardiopulmonary Rehabilitation for Heart Failure Patients in Saudi Arabia: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15208. [PMID: 36429925 PMCID: PMC9690397 DOI: 10.3390/ijerph192215208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cardiopulmonary rehabilitation (CR) serves as a core component of the management strategy for patients with heart failure (HF). CR is administered by multidisciplinary healthcare providers, but their perceptions toward delivering CR to HF patients, and the factors and barriers that might influence referral, have not been studied. This study aims to assess physicians' perceptions toward delivering CR programs to HF patients and identify factors and barriers that might influence their referral decisions. METHODS Between 15 February and 5 June 2022, a cross-sectional online survey with ten multiple-choice items was distributed to all general and cardiac physicians in Saudi Arabia. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. The statistical significance of the difference between categorical variables was determined using the chi-square (2) test. Logistic regression was used to identify referral factors. RESULTS Overall, 513 physicians (general physicians (78%) and cardiac doctors (22%)) completed the online survey, of which 65.0% (n = 332) were male. Of the general physicians, 236 (59%) had referred patients with HF to CR. Sixty-six (58%) of the cardiac doctors had referred patients with HF to CR. A hospital-supervised program was the preferred mode of delivering CR programs among 315 (79%) general physicians, while 84 (74%) cardiac doctors preferred to deliver CR programs at home. Apart from the exercise component, information about HF disease was perceived by 321 (80%) general physicians as the essential component of a CR program, while symptom management was perceived by 108 (95%) cardiac doctors as the essential component of a CR program. The most common patient-related factor that strongly influenced referral decisions was "fatigue related to disease" (63.40%). The availability of CR centers (48%) was the most common barrier preventing the referral of patients to CR. CONCLUSIONS CR is an effective management strategy for HF patients, but the lack of CR centers is a major barrier to the referral of patients. A hospital-supervised program is the preferred method of delivering CR from the general physicians' perspective, while cardiac doctors prefer home-based CR programs. Apart from the exercise component, information about HF disease and symptom management is essential components of CR programs from general physicians' and cardiac doctors' perspectives, respectively.
Collapse
Affiliation(s)
- Abdulelah M. Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia
| | - Munyra Alhotye
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh 12211, Saudi Arabia
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 32210, Saudi Arabia
| | - Saeed M. Alghamdi
- Respiratory Care Program, Clinical Technology Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 24211, Saudi Arabia
| | - Abdullah S. Alsulayyim
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
| | - Abdullah A. Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22230, Saudi Arabia
| | - Eidan M. Alzahrani
- Department of Physiotherapy, Prince Sultan Military College of Health Sciences, Dammam 32210, Saudi Arabia
| | - Rayan A. Siraj
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa 36291, Saudi Arabia
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al-Qura University, Mecca 36291, Saudi Arabia
| |
Collapse
|
4
|
Borsoi L, Callea G, Tarricone R. How to Reduce Inequity of Access to Cardiac Rehabilitation After Surgical Aortic Valve Replacement. Recommendations for the Post–COVID-19 Era From a Real-World, Population-Based Study. Clin Ther 2022; 44:491-507. [DOI: 10.1016/j.clinthera.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 11/03/2022]
|
5
|
Daw P, Withers TM, van Zanten JJCSV, Harrison A, Greaves CJ. A systematic review of provider-and system-level factors influencing the delivery of cardiac rehabilitation for heart failure. BMC Health Serv Res 2021; 21:1267. [PMID: 34814927 PMCID: PMC8611948 DOI: 10.1186/s12913-021-07174-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 10/14/2021] [Indexed: 12/24/2022] Open
Abstract
Background There is a longstanding research-to-practice gap in the delivery of cardiac rehabilitation for patients with heart failure. Despite adequate evidence confirming that comprehensive cardiac rehabilitation can improve quality of life and decrease morbidity and mortality in heart failure patients, only a fraction of eligible patients receives it. Many studies and reviews have identified patient-level barriers that might contribute to this disparity, yet little is known about provider- and system-level influences. Methods A systematic review using narrative synthesis. The aims of the systematic review were to a) determine provider- and system-level barriers and enablers that affect the delivery of cardiac rehabilitation for heart failure and b) juxtapose identified barriers with possible solutions reported in the literature. A comprehensive search strategy was applied to the MEDLINE, Embase, PsycINFO, CINAHL Plus, EThoS and ProQuest databases. Articles were included if they were empirical, peer-reviewed, conducted in any setting, using any study design and describing factors influencing the delivery of cardiac rehabilitation for heart failure patients. Data were synthesised using inductive thematic analysis and a triangulation protocol to identify convergence/contradiction between different data sources. Results Seven eligible studies were identified. Thematic analysis identified nine overarching categories of barriers and enablers which were classified into 24 and 26 themes respectively. The most prevalent categories were ‘the organisation of healthcare system’, ‘the organisation of cardiac rehabilitation programmes’, ‘healthcare professional’ factors and ‘guidelines’. The most frequent themes included ‘lack of resources: time, staff, facilities and equipment’ and ‘professional’s knowledge, awareness and attitude’. Conclusions Our systematic review identified a wide range of provider- and system-level barriers impacting the delivery of cardiac rehabilitation for heart failure, along with a range of potential solutions. This information may be useful for healthcare professionals to deliver, plan or commission cardiac rehabilitation services, as well as future research. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07174-w.
Collapse
Affiliation(s)
- Paulina Daw
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Thomas M Withers
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | | | | | - Colin J Greaves
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| |
Collapse
|
6
|
Sukul D, Seth M, Thompson MP, Keteyian SJ, Boyden TF, Syrjamaki JD, Yaser J, Likosky DS, Gurm HS. Hospital and Operator Variation in Cardiac Rehabilitation Referral and Participation After Percutaneous Coronary Intervention: Insights From Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Circ Cardiovasc Qual Outcomes 2021; 14:e008242. [PMID: 34749515 DOI: 10.1161/circoutcomes.121.008242] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite its established benefit and strong endorsement in international guidelines, cardiac rehabilitation (CR) use remains low. Identifying determinants of CR referral and use may help develop targeted policies and quality improvement efforts. We evaluated the variation in CR referral and use across percutaneous coronary intervention (PCI) hospitals and operators. METHODS We performed a retrospective observational cohort study of all patients who underwent PCI at 48 nonfederal Michigan hospitals between January 1, 2012 and March 31, 2018 and who had their PCI clinical registry record linked to administrative claims data. The primary outcomes included in-hospital CR referral and CR participation, defined as at least one outpatient CR visit within 90 days of discharge. Bayesian hierarchical regression models were fit to evaluate the association between PCI hospital and operator with CR referral and use after adjusting for patient characteristics. RESULTS Among 54 217 patients who underwent PCI, 76.3% received an in-hospital referral for CR, and 27.1% attended CR within 90 days after discharge. There was significant hospital and operator level variation in in-hospital CR referral with median odds ratios of 3.88 (95% credible interval [CI], 3.06-5.42) and 1.64 (95% CI, 1.55-1.75), respectively, and in CR participation with median odds ratios of 1.83 (95% CI, 1.63-2.15) and 1.40 (95% CI, 1.35-1.47), respectively. In-hospital CR referral was significantly associated with an increased likelihood of CR participation (adjusted odds ratio, 1.75 [95% CI, 1.52-2.01]), and this association varied by treating PCI hospital (odds ratio range, 0.92-3.75) and operator (odds ratio range, 1.26-2.82). CONCLUSIONS In-hospital CR referral and 90-day CR use after PCI varied significantly by hospital and operator. The association of in-hospital CR referral with downstream CR use also varied across hospitals and less so across operators suggesting that specific hospitals and operators may more effectively translate CR referrals into downstream use. Understanding the factors that explain this variation will be critical to developing strategies to improve CR participation overall.
Collapse
Affiliation(s)
- Devraj Sukul
- Division of Cardiovascular Medicine, Department of Internal Medicine (D.S., M.S., H.S.G.), University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation (D.S., M.P.T., D.S.L.), University of Michigan, Ann Arbor.,Division of Cardiology, Department of Internal Medicine, VA Ann Arbor Healthcare System, MI (D.S.. H.S.G.)
| | - Milan Seth
- Division of Cardiovascular Medicine, Department of Internal Medicine (D.S., M.S., H.S.G.), University of Michigan, Ann Arbor
| | - Michael P Thompson
- Institute for Healthcare Policy and Innovation (D.S., M.P.T., D.S.L.), University of Michigan, Ann Arbor.,Michigan Value Collaborative (M.P.T., J.D.S., J.Y.), University of Michigan, Ann Arbor.,Department of Cardiac Surgery (M.P.T., D.S.L.), University of Michigan, Ann Arbor
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI (S.J.K.)
| | - Thomas F Boyden
- Division of Cardiology, Spectrum Health, Grand Rapids, MI (T.F.B.)
| | - John D Syrjamaki
- Michigan Value Collaborative (M.P.T., J.D.S., J.Y.), University of Michigan, Ann Arbor
| | - Jessica Yaser
- Michigan Value Collaborative (M.P.T., J.D.S., J.Y.), University of Michigan, Ann Arbor
| | - Donald S Likosky
- Institute for Healthcare Policy and Innovation (D.S., M.P.T., D.S.L.), University of Michigan, Ann Arbor.,Department of Cardiac Surgery (M.P.T., D.S.L.), University of Michigan, Ann Arbor
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine (D.S., M.S., H.S.G.), University of Michigan, Ann Arbor.,Division of Cardiology, Department of Internal Medicine, VA Ann Arbor Healthcare System, MI (D.S.. H.S.G.)
| |
Collapse
|
7
|
Farah R, Groot W, Pavlova M. Knowledge, attitudes and practices survey of cardiac rehabilitation among cardiologists and cardiac surgeons in Lebanon. Egypt Heart J 2021; 73:87. [PMID: 34648092 PMCID: PMC8517050 DOI: 10.1186/s43044-021-00212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background Cardiovascular diseases (CVDs) are among the leading causes of morbidity and mortality worldwide. Over three quarters of the cardiovascular deaths take place in low and middle-income countries. Despite the benefits, Cardiac Rehabilitation (CR) is still not routinely and not universally available. Numerous studies have found that barriers to access to CR are correlated with providers, patients and environment characteristics. This first national survey on CR in Lebanon assesses the knowledge, attitudes and practices among physicians. In addition, the study identifies what the main barriers to access to CR are and provides suggestions for the implementation of CR in the country. Results The response rate was 41.5% (n = 83). Results show that the cardiologists have medium level of knowledge about CR and its multidisciplinary content. Physicians support the implementation of a comprehensive CR program in the country. 50% of the physicians recommended first to solve the financial issues before implementing a CR program. Supplementary learning about the benefits of CR is highly recommended to enroll more patients with CVD into CR. In addition, the lack of specialists in the field, lack of motivation for patients to enroll to CR and inconvenient location of the rehabilitation centers were identified as major barriers by the respondents. Conclusions The role of physicians in promoting patient enrolment should be optimized and exploited in the country. The access barriers identified can help to develop CR programs and to improve CR referral and enrolment rates. Funds from private parties and a budget from the government are needed to launch new CR programs in the country. Further research is needed to provide evidence on the CR benefits in Lebanon and to motivate policy-makers to place priority on the establishment of a comprehensive CR program in the country. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-021-00212-2.
Collapse
Affiliation(s)
- Rebecca Farah
- Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center; Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. .,Department of Rehabilitation and Physical Therapy (Group A); Delta-Chirec Hospitals Group, Brussels, Belgium.
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center; Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Center; Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| |
Collapse
|
8
|
Rodrigo SF, Van Exel HJ, Van Keulen N, Van Winden L, Beeres SLMA, Schalij MJ. Referral and participation in cardiac rehabilitation of patients following acute coronary syndrome; lessons learned. IJC HEART & VASCULATURE 2021; 36:100858. [PMID: 34466654 PMCID: PMC8382985 DOI: 10.1016/j.ijcha.2021.100858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/27/2021] [Accepted: 08/10/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE Cardiac rehabilitation (CR) after hospitalization for acute coronary syndrome (ACS) has shown to reduce mortality, readmissions, and improve quality of life. CR is recommended by international guidelines but previous studies have shown low participation rates. Systematic CR referral might improve CR participation. METHODS The present study evaluates CR referral and CR participation of patients hospitalized for ACS in 2017 and treated according to local protocol, which includes systematic CR referral. Participation rate was divided into a group that finished the CR program and drop outs. In addition, factors associated with CR referral and participation rate were evaluated. RESULTS A total of 469 patients eligible for CR were included in the study, of which 377 (80%) were referred for CR and 353 (75%) participated in CR. Ninety percent of participants completed the CR program. Factors independently associated with CR referral included age (50-60 year vs. > 70 year: odds ratio [OR] 4.7, 95% confidence interval [CI] 1.98-11.2), diagnosis (ST-elevation myocardial infarction vs. unstable angina: OR 17.7, CI 7.59-41.7), previous cardiovascular disease (OR 0.4, CI 0.19-0.73) and left ventricular dysfunction vs. normal function (OR 2.2, CI 1.11-4.52). A larger distance to the CR center was associated with lower CR participation (<5km vs. > 20 km: OR 3.1, CI 1.20-7.72). CONCLUSIONS Systematic CR referral in ACS patients results in high CR referral (80%) and participation (75%) rates. CR adherence might be further improved by increasing CR referral, especially in older patients and patients with NSTEMI or unstable angina.
Collapse
Key Words
- ACS, Acute coronary syndrome
- CI, Confidence interval
- CR, Cardiac rehabilitation
- CVA, Cerebrovascular accident
- Cardiac rehabilitation
- DBC, Diagnosis treatment combination (Diagnose behandel combinatie)
- EPD, Electronic patient dossier
- LV, Left ventricular
- NSTEMI, Non ST-elevation myocardial infarction
- OR, Odds ratio
- Patient participation
- Referral
- SES, Socio-economic status
- STEMI, ST-elevation myocardial infarction
- Secondary prevention
- TIA, Transient ischemic attack
Collapse
Affiliation(s)
- Sander F Rodrigo
- Basalt Rehabilitation, Leiden, the Netherlands
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Nicole Van Keulen
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Loes Van Winden
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Saskia L M A Beeres
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin J Schalij
- Deparment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
9
|
Cardiovascular rehabilitation in patients aged 70-year-old or older: benefits on functional capacity, physical activity and metabolic profile in younger vs. older patients. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2020; 17:544-553. [PMID: 33117418 PMCID: PMC7568038 DOI: 10.11909/j.issn.1671-5411.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background The benefits of exercise-based cardiac rehabilitation (EBCR) programs in post-acute myocardial infarction (AMI) patients have been demonstrated. Our aim was to assess the impact of EBCR in ≥ 70-years-old vs. younger post-AMI patients. Methods We retrospectively evaluated patients who underwent a supervised EBCR protocol, twice a week during 6-12 weeks. We evaluated changes in several outcomes based on pre- and post-CRP assessments. Results Of a total of 1607 patients, 333 (21%) were ≥ 70-years-old. After the EBCR, an overall improvement on functional capacity, daily physical activity, lipid profile, body mass index, glycated hemoglobin (HbA1c), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-reactive protein was observed in both younger and older patients (P < 0.05). Older patients showed a smaller benefit on the increment of daily physical activity and lipid profile improvement, but a larger reduction in NT-pro-BNP. In the multivariate analysis, only improvements on daily physical activity and HbA1c were dependent on age. Conclusion As their younger counterparts, older patients, significantly improved functional capacity, metabolic parameters and level of daily physical activity after EBCR.
Collapse
|
10
|
|
11
|
Elsakr C, Bulger DA, Roman S, Kirolos I, Khouzam RN. Barriers physicians face when referring patients to cardiac rehabilitation: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:414. [PMID: 31660313 DOI: 10.21037/atm.2019.07.61] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
While cardiac rehabilitation (CR) has been shown to be a beneficial form of secondary prevention for patients with cardiovascular disease, barriers of referral to CR still exist for patients. Barriers that specifically make it difficult for physicians to make the referral could be worthwhile to examine. This narrative review hypothesizes that increasing awareness and education on the various aspects of CR as well as simplifying the referral process could lead to increased referral rates as they target physician-related barriers. This narrative review seeks to further understand the physician-related barriers of low CR awareness and hindering referral processes. A search in Scopus was conducted with preference for articles examining CR referral strategies used by physicians; physicians' awareness of CR programs; physicians' perceptions, beliefs, or knowledge of the benefits of CR; or physicians' experience with or understanding of the selection process of CR programs, including indications for referral. Two systematic reviews and two observational studies were selected for discussion. Three of the selected studies had findings supporting the notion that increasing physicians' awareness of CR could impact referral rates. One of the studies evaluated the perceptions that physicians and CR programs had on various referral strategies. While more study is needed to assess the actual level of knowledge and awareness physicians have regarding CR, this review supports using educational interventions as well as targeting various aspects of the referral process for improving referral rates.
Collapse
Affiliation(s)
- Carol Elsakr
- Department of Medicine, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - David A Bulger
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sherif Roman
- Department of Medicine, Cairo University, Giza Governorate, Egypt
| | - Irene Kirolos
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rami N Khouzam
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
12
|
Abdelhalem AM, Shabana AM, Onsy AM, Gaafar AE. High intensity interval training exercise as a novel protocol for cardiac rehabilitation program in ischemic Egyptian patients with mild left ventricular dysfunction. Egypt Heart J 2018; 70:287-294. [PMID: 30591745 PMCID: PMC6303527 DOI: 10.1016/j.ehj.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/30/2018] [Indexed: 11/17/2022] Open
Abstract
Background Exercise-based Cardiac rehabilitation (CR) plays a major role in reducing mortality and morbidity in patients with coronary artery disease (CAD). The standard protocol is usually of moderate intensity exercise. High-intensity interval training (HIIT) consists of alternating periods of intensive aerobic exercise with periods of passive or active moderate/mild intensity recovery. Aim This study aimed to assess HIIT program for ischemic patients attending CR after percutaneous coronary intervention (PCI) who have mild left ventricular dysfunction and to compare its effect on the functional capacity and quality of life with standard exercise CR program. Patients and methods Our study included 40 patients with documented CAD, who participated in the outpatient CR program in Ain Shams University hospital (Al-Demerdash Hospital) divided into two equal groups, each included 20 patients. Group A included the patients who underwent standard cardiac rehabilitation program, while group B joined the high intensity interval training exercise protocol. Results Groups A and B showed significant improvement in all items of comparison; especially functional capacity, lipid profile and quality of life. Group B showed better improvements in the emotional well-being items of QOL parameters. Conclusion We emphasize the positive effects of exercise-based CR program on patients with CAD and mild left ventricular dysfunction after PCI. The novel high intensity cardiac training proved to be safe and at least as beneficial as the standard moderate intensity cardiac training protocols, with better quality of life improvement.
Collapse
|
13
|
Resurrección DM, Moreno-Peral P, Gómez-Herranz M, Rubio-Valera M, Pastor L, Caldas de Almeida JM, Motrico E. Factors associated with non-participation in and dropout from cardiac rehabilitation programmes: a systematic review of prospective cohort studies. Eur J Cardiovasc Nurs 2018; 18:38-47. [PMID: 29909641 DOI: 10.1177/1474515118783157] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although evidence exists for the efficacy of cardiac rehabilitation programmes to reduce morbidity and mortality among patients with cardiovascular disease, cardiac rehabilitation programmes are underused. We aimed systematically to review the evidence from prospective cohort studies on factors associated with non-participation in and/or dropping out from cardiac rehabilitation programmes. METHODS MedLine, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications from inception to February 2018. Search terms included (a) coronary heart disease and other cardiac conditions; (b) cardiac rehabilitation and secondary prevention; and (c) non-participation in and/or dropout. Databases were searched following the PRISMA statement. Study selection, data extraction and the assessment of study quality were performed in duplicate. RESULTS We selected 43 studies with a total of 63,425 patients from 10 different countries that met the inclusion criteria. Factors associated with non-participation in and dropout from cardiac rehabilitation were grouped into six broad categories: intrapersonal factors, clinical factors, interpersonal factors, logistical factors, cardiac rehabilitation programme factors and health system factors. We found that clinical factors, logistical factors and health system factors were the main factors assessed for non-participation in cardiac rehabilitation. We also found differences between the factors associated with non-participation and dropout. CONCLUSIONS Several factors were determinant for non-participation in and dropout from cardiac rehabilitation. These findings could be useful to clinicians and policymakers for developing interventions aimed at improving participation and completion of cardiac rehabilitation, such as E-health or home-based delivery programmes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42016032973.
Collapse
Affiliation(s)
| | - Patricia Moreno-Peral
- 2 SAMSERAP Group, Primary Care Prevention and Health Promotion Research Network (RedIAPP), Spain.,3 SAMSERAP Group, Instituto de Investigación Biomédica de Malaga (IBIMA), Spain
| | | | - Maria Rubio-Valera
- 5 Research and Development Unit, Institut de Recerca Sant Joan de Déu, Spain.,6 Grupo PRISMA, Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, Spain
| | - Luis Pastor
- 7 Unidad Clínica de Cardiología, Hospital Nuestra Señora de Valme, Spain
| | | | - Emma Motrico
- 1 Departamento de Psicología, Universidad Loyola Andalucía, Spain.,2 SAMSERAP Group, Primary Care Prevention and Health Promotion Research Network (RedIAPP), Spain
| |
Collapse
|
14
|
Li S, Fonarow GC, Mukamal K, Xu H, Matsouaka RA, Devore AD, Bhatt DL. Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long-Term Mortality. J Am Heart Assoc 2018; 7:JAHA.117.008088. [PMID: 29626153 PMCID: PMC6015394 DOI: 10.1161/jaha.117.008088] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Cardiac rehabilitation (CR) referral is recommended for eligible patients, regardless of sex or race. It is unclear whether inequality in CR referral practices was associated with patients’ long‐term survival. Methods and Results We linked the American Heart Association Get With The Guidelines Coronary Artery Disease registry with Medicare claims data for 48 993 coronary artery disease patients from 365 hospitals across the United States between 2003 and 2009. We used generalized estimation equations to estimate the association between CR referral and mortality accounting for clustering within hospitals. Between 2003 and 2009, only 40% of eligible patients received CR referrals. Females were 12% less likely to receive CR referral compared with males. Black, Hispanic, and Asian patients were 20%, 36%, and 50% less likely, respectively, to receive CR referral than white patients. CR referral was associated with 40% lower 3‐year all‐cause mortality. Women and minorities who received CR referral at hospital discharge had significantly lower mortality compared with those who did not (odds ratios=0.61 [95% confidence interval, 0.56–0.66] for women, 0.75 [95% confidence interval, 0.63–0.88] for black, 0.62 [95% confidence interval, 0.50–0.79] for Hispanic, and 0.63 [95% confidence interval, 0.46–0.85] for Asian patients). Seven percent of the black versus white mortality gap could potentially be reduced by equitable CR referral. Conclusions CR referral rates at hospital discharge remained low. Gaps in receiving CR referral at hospital discharge were large for women and minorities, and the mortality gap could potentially be reduced through elimination of inequality in CR referral.
Collapse
Affiliation(s)
- Shanshan Li
- Boston University School of Medicine, Boston, MA
| | | | | | - Haolin Xu
- Duke Clinical Research Institute, Durham, NC
| | - Roland A Matsouaka
- Duke Clinical Research Institute, Durham, NC.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA
| |
Collapse
|
15
|
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.
Collapse
|
16
|
Dechaine CL, Merighi JR, O’Keefe TC. Healing the Heart: A Qualitative Study of Challenges and Motivations to Cardiac Rehabilitation Attendance and Completion among Women and Men. SEX ROLES 2017. [DOI: 10.1007/s11199-017-0873-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
17
|
Kanazawa N, Ueshima K, Tominari S, Nakayama T. Underuse of Cardiac Rehabilitation in Workers With Coronary Artery Disease - Claims Database Survey in Japan. Circ J 2017; 81:1424-1431. [PMID: 28496030 DOI: 10.1253/circj.cj-16-1260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Workers with coronary artery disease (CAD) require evidence-based care in order to return to work safely. We assessed the use of cardiac rehabilitation (CR) among workers with CAD, and identified the factors associated with CR use.Methods and Results:A retrospective cohort study based on data from a health insurance claims database was conducted. We identified workers aged ≥18 years who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) between 2006 and 2013, and reviewed the utilization of inpatient or outpatient CR. Logistic regression was used to identify the factors associated with CR use. A total of 1,699 patients were included. The frequency of inpatient and outpatient CR use was 23.7% (n=402) and 4.2% (n=72), respectively. Patients diagnosed with ST-elevated myocardial infarction were most likely to receive inpatient CR, and patients undergoing CABG were more likely to receive inpatient CR than those undergoing PCI. Moreover, inpatient CR use was associated with longer hospitalization duration, catecholamine use, and no history of chronic kidney disease. Furthermore, both unstable and stable angina were negatively correlated with outpatient CR use. CONCLUSIONS Most of the Japanese workers with CAD in this study did not undergo CR. The type of CAD was strongly associated with inpatient and outpatient CR use. Thus, a strong evidence-practice gap exists in secondary preventative care within this group of patients.
Collapse
Affiliation(s)
| | - Kenji Ueshima
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital
| | | | | |
Collapse
|
18
|
|
19
|
Claes J, Buys R, Budts W, Smart N, Cornelissen VA. Longer-term effects of home-based exercise interventions on exercise capacity and physical activity in coronary artery disease patients: A systematic review and meta-analysis. Eur J Prev Cardiol 2016; 24:244-256. [DOI: 10.1177/2047487316675823] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Jomme Claes
- Department of Cardiovascular Sciences, Division of Cardiology, KU Leuven, Belgium
| | - Roselien Buys
- Department of Cardiovascular Sciences, Division of Cardiology, KU Leuven, Belgium
- Department of Rehabilitation Sciences, Research group of Cardiovascular Rehabilitation, KU Leuven, Belgium
| | - Werner Budts
- Department of Cardiovascular Sciences, Division of Cardiology, KU Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Belgium
| | - Neil Smart
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
| | - Véronique A Cornelissen
- Department of Rehabilitation Sciences, Research group of Cardiovascular Rehabilitation, KU Leuven, Belgium
| |
Collapse
|
20
|
Worcester MUC, Murphy BM, Mee VK, Roberts SB, Goble AJ. Cardiac rehabilitation programmes: predictors of non-attendance and drop-out. ACTA ACUST UNITED AC 2016; 11:328-35. [PMID: 15292767 DOI: 10.1097/01.hjr.0000137083.20844.54] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite evidence of its benefits, attendance at cardiac rehabilitation (CR) programmes is poor. Past studies to identify predictors of non-attendance have been limited by their small sample size, particularly for female patients. The present study was designed to identify socio-demographic and clinical predictors of non-attendance and drop-out separately for men and women automatically referred to CR programmes. METHOD AND SUBJECTS Prospective study of CR programme attendance amongst 808 patients consecutively admitted over an 11-month period to one of two hospitals in Melbourne, Australia, after acute myocardial infarction (AMI), or to undergo coronary artery bypass graft surgery (CABGS) or percutaneous coronary intervention (PCI). RESULTS Of the 652 eligible patients, 573 (88%) were successfully tracked at 4 months. Of these, 284 (49.6%) had attended a CR programme, while 272 (47.5%) had not. Using logistic regression, the significant predictors of programme non-attendance among men were having had a PCI, being a non-driver, and being aged 70 or more. The only factor predictive of non-attendance for women was being aged 70 or more. Amongst attenders, 67 (23.6%) patients discontinued the programme. Being a smoker, having diabetes and being unemployed at the time of hospital admission were predictive of programme drop-out by men. Being physically inactive at admission was predictive of programme drop-out by women. CONCLUSIONS The present study demonstrated a relatively high rate of CR programme attendance. Special attention needs to be directed towards males who are older, PCI patients, smokers, unemployed or non-drivers, and females who are older or inactive.
Collapse
|
21
|
Al Quait A, Doherty P. Does cardiac rehabilitation favour the young over the old? Open Heart 2016; 3:e000450. [PMID: 27547435 PMCID: PMC4975860 DOI: 10.1136/openhrt-2016-000450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/04/2016] [Accepted: 07/07/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Although cardiac rehabilitation (CR) is a proven intervention in reducing cardiovascular mortality and morbidity there is concern that CR programme delivery may not yield comparable outcomes across age groups. PURPOSE This study sought to determine if the outcomes achieved after completing CR were influenced by age in patients with coronary heart disease. METHOD Patients were stratified into 2 age groups: young (18-65 years) and elderly (>65 years). Pre-CR and post-CR assessments were used to compute changes in 9 CR outcomes (body mass index (BMI), waist size, hyperlipidaemia, hypertension, smoking, walking fitness, physical activity, anxiety and depression). Pearson's χ(2) test was used to examine the association between the age groups and outcome. Data was extracted from the UK National Audit from July 2010 to June 2015. RESULTS A total of 203 012 young patients (55.1±7.9 years, 78% male) and 262 813 elderly patients (76.1±6.9 years, 63.9% male) were analysed. Young patients had a better ratio of improvement across a wide range of risk factors in particular smoking cessation (OR=3.3, p<0.001) while elderly patients had a better ratio of improvement in body shape risk factors BMI (OR=1.3, p<0.001), waist size in women (OR=1.3, p=0.016). CONCLUSIONS Age is a significant predictor of outcomes following CR. While elderly patients achieve better outcomes in body shape risk factors, younger patients clearly achieve better outcomes across a wider range of risk factors in particular smoking cessation.
Collapse
Affiliation(s)
- Abdulrahman Al Quait
- Department of Health Sciences, Faculty of Science , University of York , Heslington , UK
| | - Patrick Doherty
- Department of Health Sciences, Faculty of Science , University of York , Heslington , UK
| |
Collapse
|
22
|
Hamilton S, Mills B, McRae S, Thompson S. Cardiac Rehabilitation for Aboriginal and Torres Strait Islander people in Western Australia. BMC Cardiovasc Disord 2016; 16:150. [PMID: 27412113 PMCID: PMC4942995 DOI: 10.1186/s12872-016-0330-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in Australia. Australian Aboriginal and Torres Strait Islander (Indigenous) people have higher levels of CVD compared with non-Indigenous people. Cardiac Rehabilitation (CR) is an evidence-based intervention that can assist with reducing subsequent cardiovascular events and rehospitalisation. Unfortunately, attendance rates at traditional CR programs, both globally and in Australia, are estimated to be as low as 10-30 % and Indigenous people are known to be particularly under-represented. An in-depth assessment was undertaken to investigate the provision of CR and secondary preveniton services in Western Australia (WA) with a focus on rural, remote and Indigenous populations. This paper reports on the findings for Indigenous people. METHODS Cardiac rehabilitation and Aboriginal Medical Services (n = 38) were identified for interview through the Heart Foundation Directory of Western Australian Cardiac Rehabilitation and Secondary Prevention Services 2012. Semi-structured interviews with CR coordinators were conducted and included questions specific to Indigenous people. RESULTS Interviews with coordinators from 34 CR services (10 rural, 12 remote, 12 metropolitan) were conducted. Identification of Indigenous status was reported by 65 % of coordinators; referral and attendance rates of Indigenous patients differed greatly across WA. Efforts to meet the cultural needs of Indigenous patients varied and included case management (32 %), specific educational materials (35 %), use of a buddy or mentoring system (27 %), and access to an Aboriginal Health Worker (71 %). Staff cultural awareness training was available for 97 % and CR guidelines were utilised by 77 % of services. CONCLUSION The under-representation of Indigenous Australians participating in CR, as reported in the literature and more specifically in this study, mandates a concerted effort to improve services to better meet the needs of Indigenous patients with CVD as part of closing the gap in life expectancy. Improving access to culturally appropriate CR and secondary prevention in WA must be an important component of this effort given the high rates of premature cardiovascular disease affecting Indigenous people. Our findings also highlight the importance of good systematic data collection across services. Health pathways that ensure continuity of care and alternative methods of CR delivery with dedicated resources are needed.
Collapse
Affiliation(s)
- Sandra Hamilton
- />Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Belynda Mills
- />Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Shelley McRae
- />National Heart Foundation of Australia, 334 Rokeby Road, Subiaco, WA 6009 Australia
| | - Sandra Thompson
- />Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| |
Collapse
|
23
|
Sarrafzadegan N, Rabiei K, Shirani S, Kabir A, Mohammadifard N, Roohafza H. Drop-out predictors in cardiac rehabilitation programmes and the impact of sex differences among coronary heart disease patients in an Iranian sample: a cohort study. Clin Rehabil 2016; 21:362-72. [PMID: 17613578 DOI: 10.1177/0269215507072193] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective : To determine whether patients who subsequently drop out of a structured cardiac rehabilitation programme could be prospectively distinguished from those who remain in the programme based upon their initial baseline characteristics. Design : A cohort study. Setting : A referral rehabilitation department in a cardiovascular research and training institute. Subjects : One thousand one hundred and fifteen coronary heart disease patients including patients with ischaemic heart disease, and those undergoing bypass surgery or percutaneous coronary interventions. Interventions : Demographic characteristics, coronary heart disease risk factors, ejection fraction, functional capacity and laboratory tests were considered at baseline. Main measures : Patients who completed all 24 sessions of the cardiac rehabilitation programme were compared with drop-out cases who did not. Results : Four hundred and ninety-nine patients (44.8%) completed the whole cardiac rehabilitation programme. Women (adjusted odds ratio (AOR) 1.817, P < 0.001), older patients (AOR 1.015, P = 0.047), patients with lower risk of coronary heart disease (AOR 1.573, P = 0.008) or lower body mass index (BMI) (AOR 0.945, P = 0.001) and higher waist-to-hip ratio (AOR 12.871, P = 0.009) and those who were non-smokers (AOR 1.779, P = 0.001) were significantly more likely to complete cardiac rehabilitation. Conclusions : Developing interventions to address special needs of young, obese, smoker male patients who have a lower waist-to-hip ratio and higher clinical risk may be important, especially in attempts to retain this high-risk group in cardiac rehabilitation therapy.
Collapse
Affiliation(s)
- Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | | | | | | | | |
Collapse
|
24
|
Worcester MUC, Stojcevski Z, Murphy B, Goble AJ. Factors Associated with Non-Attendance at a Secondary Prevention Clinic for Cardiac Patients. Eur J Cardiovasc Nurs 2016; 2:151-7. [PMID: 14622640 DOI: 10.1016/s1474-5151(03)00031-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: A randomised controlled trial was undertaken to test the effectiveness of a secondary prevention clinic. Secondary prevention programs can improve prognosis after an acute cardiac illness. It is therefore important to encourage high participation rates. Aim: The present study was a post-hoc analysis to identify factors associated with patients’ non-attendance at the clinic. Methods: We compared the baseline socio-demographic and clinical characteristics of 83 (73.5% male) non-attending patients and a random sample of 96 (85.4% male) attending patients. Self-reported data were gathered during interviews conducted on an average of 30 months after hospital admission to investigate long-term outcomes of the clinic. Results: Using logistic regression analysis, we found that non-attendance was significantly and independently associated with being female, being under 60 years of age, having no history of high cholesterol and having no angina prior to the event. In bivariate analyses, non-attendance was also associated with being born overseas and not having private health insurance. Conclusions: Likely non-attending patients should be identified early and more effective strategies should be devised to facilitate their participation in secondary prevention programs.
Collapse
|
25
|
Gallagher R, Neubeck L, Du H, Astley C, Berry NM, Hill MN, Clark R. Facilitating or getting in the way? The effect of clinicians' knowledge, values and beliefs on referral and participation. Eur J Prev Cardiol 2016; 23:1141-50. [PMID: 26830147 DOI: 10.1177/2047487316630085] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/12/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite the compelling evidence of the benefits of cardiac rehabilitation (CR) on risk factor modification, quality of life and mortality reduction, a significant proportion of eligible patients are not referred or do not participate. Factors influencing CR referral and participation are complex and are likely patient, referral system and clinician-related. Little is known about clinician-related factors, which include attitudes, values and beliefs towards CR, or how these factors affect patient referral and attendance. This review examines the current evidence in the literature in relation to clinicians' attitudes, values and beliefs about CR. METHODS A review of the literature was conducted on studies in relation to clinicians' attitudes, values and beliefs toward CR. An expert consensus methodology was used to develop the concepts presented in this paper. RESULTS Besides guidelines, a range of other factors influence clinicians' view about CR. This review suggests that clinicians lacking cardiac qualifications may have limited knowledge and awareness of CR and its benefits. Low agreement among clinicians on who is more likely to benefit from CR was also identified. Clinicians' personal lifestyle and health belief, the availability and quality of local the CR programme, and the lack of a standard administrative process of referral can also hinder the referral of patients to CR. CONCLUSIONS Clinician-related factors are important to consider in relation to CR referral and participation. Education for clinicians, discussion of local services and the support of an efficacious system at programme and organisation levels are essential.
Collapse
Affiliation(s)
- Robyn Gallagher
- Sydney Nursing School, The University of Sydney, Australia Faculty of Health, University of Technology, Sydney, Australia
| | - Lis Neubeck
- Sydney Nursing School, The University of Sydney, Australia
| | - Huiyun Du
- School of Nursing and Midwifery, Flinders University, Australia
| | - Carolyn Astley
- Sydney Nursing School, The University of Sydney, Australia Faculty of Health, University of Technology, Sydney, Australia Heart Foundation SA, Flinders University, Australia
| | - Narelle M Berry
- School of Nursing and Midwifery, Flinders University, Australia
| | - Martha N Hill
- School of Nursing, The Johns Hopkins University, USA
| | - Robyn Clark
- Faculty of Health, University of Technology, Sydney, Australia School of Nursing and Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Australia Sansom Institute, University of South Australia, Australia South Australian Health and Medical Research Institute, Australia
| |
Collapse
|
26
|
Grossman JAC. Cardiac Rehabilitation Enrollment and the Impact of Systematic Nursing Interventions for Postmyocardial Infarction and Stent Patients. Clin Nurs Res 2015; 25:378-90. [PMID: 26655562 DOI: 10.1177/1054773815620777] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A randomized experimental design was used to determine the most effective intervention for enhancing cardiac rehabilitation (CR) enrollment for postmyocardial infarction and stent patients. The 104 subjects (70 males and 34 females; 23-87 years old) were patients with a discharge diagnosis of a myocardial infarction followed by a percutaneous coronary intervention, which included a percutaneous transluminal coronary angioplasty and the placement of one or more coronary stents. Regardless of the intervention, patients who received face-to-face nursing interventions were more likely to enroll in CR than were patients who had indirect interventions, χ(2)(3) = 32.84, p < .001. Patients who experienced an entrance interview were most likely to enroll, χ(2)(1) = 86.80, p < .001. Direct logistic regression determined that the full model was statistically significant for all predictors, χ(2)(5), 105.56, p < .001, with the strongest predictor, the entrance interview, having an odds ratio of 1.73.
Collapse
|
27
|
Gaalema DE, Cutler AY, Higgins ST, Ades PA. Smoking and cardiac rehabilitation participation: Associations with referral, attendance and adherence. Prev Med 2015; 80:67-74. [PMID: 25900804 PMCID: PMC4592377 DOI: 10.1016/j.ypmed.2015.04.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Continued smoking after a cardiac event greatly increases mortality risk. Smoking cessation and participation in cardiac rehabilitation (CR) are effective in reducing morbidity and mortality. However, these two behaviors may interact; those who smoke may be less likely to access or complete CR. This review explores the association between smoking status and CR referral, attendance, and adherence. METHODS A systematic literature search was conducted examining associations between smoking status and CR referral, attendance and completion in peer-reviewed studies published through July 1st, 2014. For inclusion, studies had to report data on outpatient CR referral, attendance or completion rates and smoking status had to be considered as a variable associated with these outcomes. RESULTS Fifty-six studies met inclusion criteria. In summary, a history of smoking was associated with an increased likelihood of referral to CR. However, smoking status also predicted not attending CR and was a strong predictor of CR dropout. CONCLUSION Continued smoking after a cardiac event predicts lack of attendance in, and completion of CR. The issue of smoking following a coronary event deserves renewed attention.
Collapse
Affiliation(s)
- Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
| | - Alexander Y Cutler
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA
| | - Philip A Ades
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Medicine, Division of Cardiology, University of Vermont Medical Center, USA
| |
Collapse
|
28
|
Affiliation(s)
- Yuichi J Shimada
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Benjamin M Scirica
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts; TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
| |
Collapse
|
29
|
Dahhan A, Maddox WR, Krothapalli S, Farmer M, Shah A, Ford B, Rhodes M, Matthews L, Barnes VA, Sharma GK. Education of Physicians and Implementation of a Formal Referral System Can Improve Cardiac Rehabilitation Referral and Participation Rates after Percutaneous Coronary Intervention. Heart Lung Circ 2015; 24:806-16. [PMID: 25797328 DOI: 10.1016/j.hlc.2015.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/06/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an effective preventive measure that remains underutilised in the United States. The study aimed to determine the CR referral rate (RR) after percutaneous coronary intervention (PCI) at an academic tertiary care centre, identify barriers to referral, and evaluate awareness of CR benefits and indications (CRBI) among cardiologists. Subsequently, it aimed to evaluate if an intervention consisting of physicians' education about CRBI and implementation of a formal CR referral system could improve RR and consequently participation rate (PR). METHODS Data were retrospectively collected for all consecutive patients who underwent PCI over 12 months. Referral rate was determined and variables were compared for differences between referred and non-referred patients. A questionnaire was distributed among the physicians in the Division of Cardiology to assess awareness of CRBI and referral practice patterns. After implementation of the intervention, data were collected retrospectively for consecutive patients who underwent PCI in the following six months. Referral rate and changes in PRs were determined. RESULTS Prior to the intervention, RR was 17.6%. Different barriers were identified, but the questionnaire revealed lack of physicians' awareness of CRBI and inconsistent referral patterns. After the intervention, RR increased to 88.96% (Odds Ratio 37.73, 95% CI 21.34-66.70, p<0.0001) and PR increased by 32.8% to reach 26%. Personal endorsement of CRBI by cardiologists known to patients increased CR program graduation rate by 35%. CONCLUSIONS Cardiologists' awareness of CRBI increases CR RR and their personal endorsement improves PR and compliance. Education of providers and implementation of a formal referral system can improve RR and PR.
Collapse
Affiliation(s)
| | | | | | | | - Amit Shah
- Georgia Regents University, Augusta, GA, USA
| | | | - Marc Rhodes
- Georgia Regents University, Augusta, GA, USA
| | | | | | | |
Collapse
|
30
|
Gender, race and cardiac rehabilitation in the United States: is there a difference in care? Am J Med Sci 2014; 348:146-52. [PMID: 25010188 DOI: 10.1097/maj.0000000000000306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Coronary heart disease is the leading cause of death within the United States, involving both genders and among all races and ethnic populations. Cardiac rehabilitation (CR) has been shown to significantly improve morbidity and mortality, and these benefits extend to individuals of both genders and all ages with coronary heart disease. Despite this, referral and participation rates remain surprisingly low. Furthermore, women and minorities have even lower referral rates than do their male and white counterparts. Over the course of this article, we will review CR referral and participation among women, as well as racial and ethnic minorities in the United States. We will also examine barriers to CR participation among these subgroups.
Collapse
|
31
|
|
32
|
|
33
|
|
34
|
Nallamothu BK, Tommaso CL, Anderson HV, Anderson JL, Cleveland JC, Dudley RA, Duffy PL, Faxon DP, Gurm HS, Hamilton LA, Jensen NC, Josephson RA, Malenka DJ, Maniu CV, McCabe KW, Mortimer JD, Patel MR, Persell SD, Rumsfeld JS, Shunk KA, Smith SC, Stanko SJ, Watts B. ACC/AHA/SCAI/AMA–Convened PCPI/NCQA 2013 Performance Measures for Adults Undergoing Percutaneous Coronary Intervention. J Am Coll Cardiol 2014; 63:722-745. [DOI: 10.1016/j.jacc.2013.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
35
|
Beckstead JW, Pezzo MV, Beckie TM, Shahraki F, Kentner AC, Grace SL. Physicians' tacit and stated policies for determining patient benefit and referral to cardiac rehabilitation. Med Decis Making 2014; 34:63-74. [PMID: 23784848 PMCID: PMC4527843 DOI: 10.1177/0272989x13492017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND / PURPOSE The benefits of prescribing cardiac rehabilitation (CR) for patients following heart surgery is well documented; however, physicians continue to underuse CR programs, and disparities in the referral of women are common. Previous research into the causes of these problems has relied on self-report methods, which presume that physicians have insight into their referral behavior and can describe it accurately. In contrast, the research presented here used clinical judgment analysis (CJA) to discover the tacit judgment and referral policies of individual physicians. The specific aims were to determine 1) what these policies were, 2) the degree of self-insight that individual physicians had into their own policies, 3) the amount of agreement among physicians, and 4) the extent to which judgments were related to attitudes toward CR. METHODS Thirty-six Canadian physicians made judgments and decisions regarding 32 hypothetical cardiac patients, each described on 5 characteristics (gender, age, type of cardiovascular procedure, presence/absence of musculoskeletal pain, and degree of motivation) and then completed the 19 items of the Attitude towards Cardiac Rehabilitation Referral scale. RESULTS Consistent with previous studies, there was wide variation among physicians in their tacit and stated judgment policies, and self-insight was modest. On the whole, physicians showed evidence of systematic gender bias as they judged women as less likely than men to benefit from CR. Insight data suggest that 1 in 3 physicians were unaware of their own bias. There was greater agreement among physicians in how they described their judgments (stated policies) than in how they actually made them (tacit policies). Correlations between attitude statements and CJA measures were modest. CONCLUSIONS These findings offer some explanation for the slow progress of efforts to improve CR referrals and for gender disparities in referral rates.
Collapse
Affiliation(s)
| | - Mark V Pezzo
- University of South Florida St. Petersburg, St. Petersburg, FL (MVP)
| | | | | | - Amanda C Kentner
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA (ACK)
| | | |
Collapse
|
36
|
Prince DZ, Sobolev M, Gao J, Taub CC. Racial disparities in cardiac rehabilitation initiation and the effect on survival. PM R 2013; 6:486-92. [PMID: 24321413 DOI: 10.1016/j.pmrj.2013.11.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 10/04/2013] [Accepted: 11/23/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine predictors of initiation and adherence, identify racial disparities, and compare the survival benefit of cardiac rehabilitation between a white and a unique predominantly non-white minority in an urban environment. DESIGN A retrospective cohort study. SETTING The outpatient cardiac rehabilitation program at Montefiore Medical Center, Bronx, New York. PATIENTS Consecutive patients (n = 822) referred to outpatient cardiac rehabilitation were evaluated. METHODS Baseline characteristics and outcomes were ascertained from medical records. Multivariate logistic regression was used to examine the association among initiation, age, gender, race, reason for referral, and copayment. Kaplan-Meier analysis was performed to evaluate mortality outcomes. MAIN OUTCOME MEASUREMENTS Racial disparities in rates of initiation, adherence and completion, and survival benefit associated with cardiac rehabilitation. RESULTS Among 822 patients referred (51.5% non-white minorities, 61.1% male), 59.4% initiated cardiac rehabilitation. Non-white minorities initiated cardiac rehabilitation less often than did white patients (54.4% versus 65.2%, P = .003). After adjustment, white patients were 77.5% more likely to initiate cardiac rehabilitation (odds ratio 1.78; 95% confidence interval 1.13-2.80). Both white populations and non-white minorities who participated in cardiac rehabilitation had a lower risk of death (P = .0022). CONCLUSIONS In a predominantly minority population, racial disparities exist among cardiac rehabilitation participants. Minorities were less likely to initiate cardiac rehabilitation. Gender, referral patterns, and the presence of copayment did not influence initiation. Cardiac rehabilitation initiation was associated with decreased mortality.
Collapse
Affiliation(s)
- David Z Prince
- The Arthur S. Abramson Department of Rehabilitation Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY(∗)
| | - Maria Sobolev
- Division of Cardiology, Department of Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY(†)
| | - Ju Gao
- Division of Cardiology, Department of Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY(‡)
| | - Cynthia C Taub
- Division of Cardiology, Department of Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, 1825 Eastchester Road, Room WT120, Bronx, NY 10461(§).
| |
Collapse
|
37
|
Clark RA, Conway A, Poulsen V, Keech W, Tirimacco R, Tideman P. Alternative models of cardiac rehabilitation: a systematic review. Eur J Prev Cardiol 2013; 22:35-74. [PMID: 23943649 DOI: 10.1177/2047487313501093] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The traditional hospital-based model of cardiac rehabilitation faces substantial challenges, such as cost and accessibility. These challenges have led to the development of alternative models of cardiac rehabilitation in recent years. The aim of this study was to identify and critique evidence for the effectiveness of these alternative models. A total of 22 databases were searched to identify quantitative studies or systematic reviews of quantitative studies regarding the effectiveness of alternative models of cardiac rehabilitation. Included studies were appraised using a Critical Appraisal Skills Programme tool and the National Health and Medical Research Council's designations for Level of Evidence. The 83 included articles described interventions in the following broad categories of alternative models of care: multifactorial individualized telehealth, internet based, telehealth focused on exercise, telehealth focused on recovery, community- or home-based, and complementary therapies. Multifactorial individualized telehealth and community- or home-based cardiac rehabilitation are effective alternative models of cardiac rehabilitation, as they have produced similar reductions in cardiovascular disease risk factors compared with hospital-based programmes. While further research is required to address the paucity of data available regarding the effectiveness of alternative models of cardiac rehabilitation in rural, remote, and culturally and linguistically diverse populations, our review indicates there is no need to rely on hospital-based strategies alone to deliver effective cardiac rehabilitation. Local healthcare systems should strive to integrate alternative models of cardiac rehabilitation, such as brief telehealth interventions tailored to individual's risk factor profiles as well as community- or home-based programmes, in order to ensure there are choices available for patients that best fit their needs, risk factor profile, and preferences.
Collapse
Affiliation(s)
- Robyn A Clark
- School of Nursing and Midwifery, Flinders University, Adelaide, Australia
| | - Aaron Conway
- School of Nursing and Institute of Health and Biomedical Innovation, Queensland University Technology, Australia
| | | | - Wendy Keech
- National Heart Foundation of Australia, Australia
| | - Rosy Tirimacco
- Integrated Cardiovascular Clinical Network, South Australia
| | | |
Collapse
|
38
|
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Zoghbi WA, Arend TE, Oetgen WJ, May C, Bradfield L, Keller S, Ramadhan E, Tomaselli GF, Brown N, Robertson RM, Whitman GR, Bezanson JL, Hundley J. 2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. Circulation 2013; 127:e663-828. [DOI: 10.1161/cir.0b013e31828478ac] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
39
|
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.
Collapse
Affiliation(s)
- Gabriela L M Ghisi
- Exercise Sciences Department, Faculty of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
40
|
Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Jneid H, Ettinger SM, Ganiats TG, Philippides GJ, Jacobs AK, Halperin JL, Albert NM, Creager MA, DeMets D, Guyton RA, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61:e179-347. [PMID: 23639841 DOI: 10.1016/j.jacc.2013.01.014] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
41
|
Clark RA, Coffee N, Turner D, Eckert KA, van Gaans D, Wilkinson D, Stewart S, Tonkin AM. Access to cardiac rehabilitation does not equate to attendance. Eur J Cardiovasc Nurs 2013; 13:235-42. [PMID: 23598464 DOI: 10.1177/1474515113486376] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Timely access to appropriate cardiac care is critical for optimizing positive outcomes after a cardiac event. Attendance at cardiac rehabilitation (CR) remains less than optimal (10%-30%). Our aim was to derive an objective, comparable, geographic measure reflecting access to cardiac services after a cardiac event in Australia. METHODS An expert panel defined a single patient care pathway and a hierarchy of the minimum health services for CR and secondary prevention. Using geographic information systems a numeric/alpha index was modelled to describe access before and after a cardiac event. The aftercare phase was modelled into five alphabetical categories: from category A (access to medical service, pharmacy, CR, pathology within 1 h) to category E (no services available within 1 h). RESULTS Approximately 96% or 19 million people lived within 1 h of the four basic services to support CR and secondary prevention, including 96% of older Australians and 75% of the indigenous population. Conversely, 14% (64,000) indigenous people resided in population locations that had poor access to health services that support CR after a cardiac event. CONCLUSION Results demonstrated that the majority of Australians had excellent 'geographic' access to services to support CR and secondary prevention. Therefore, it appears that it is not the distance to services that affects attendance. Our 'geographic' lens has identified that more research on socioeconomic, sociological or psychological aspects to attendance is needed.
Collapse
Affiliation(s)
- Robyn A Clark
- 1School of Nursing and Midwifery, Flinders University, South Australia, Australia
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Menezes AR, Lavie CJ, Milani RV, Arena RA, Church TS. Cardiac rehabilitation and exercise therapy in the elderly: Should we invest in the aged? J Geriatr Cardiol 2012; 9:68-75. [PMID: 22783325 PMCID: PMC3390101 DOI: 10.3724/sp.j.1263.2012.00068] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 12/16/2011] [Accepted: 12/23/2011] [Indexed: 12/16/2022] Open
Abstract
Coronary heart disease (CHD) is the leading cause of death worldwide and becomes increasingly prevalent among patients aged 65 years and older. Elderly patients are at a higher risk for complications and accelerated physical deconditioning after a cardiovascular event, especially compared to their younger counterparts. The last few decades were privy to multiple studies that demonstrated the beneficial effects of cardiac rehabilitation (CR) and exercise therapy on mortality, exercise capacity, psychological risk factors, inflammation, and obesity among patients with CHD. Unfortunately, a significant portion of the available data in this field pertains to younger patients. A viable explanation is that older patients are grossly underrepresented in these programs for multiple reasons starting with the patient and extending to the physician. In this article, we will review the benefits of CR programs among the elderly, as well as some of the barriers that hinder their participation.
Collapse
Affiliation(s)
- Arthur R Menezes
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute Ochsner Clinical School, The University of Queensland School of Medicine, 1514, Jefferson Highway, New Orleans, LA 70121, USA
| | | | | | | | | |
Collapse
|
43
|
Clark RA, Coffee N, Turner D, Eckert KA, van Gaans D, Wilkinson D, Stewart S, Tonkin AM. Application of Geographic Modeling Techniques to Quantify Spatial Access to Health Services Before and After an Acute Cardiac Event. Circulation 2012; 125:2006-14. [PMID: 22451583 DOI: 10.1161/circulationaha.111.083394] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services.
Methods and Results
An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), the team developed a numeric/alphabetic index at 2 points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alphabetic) measured access to 4 basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) when a patient returned to his or her community. The numeric index ranged from 1 (access to principal referral center with cardiac catheterization service ≤1 hour) to 8 (no ambulance service, >3 hours to medical facility, air transport required). The alphabetic index ranged from A (all 4 services available within a 1-hour drive-time) to E (no services available within 1 hour). The panel found that 13.9 million Australians (71%) resided within Cardiac ARIA 1A locations (hospital with cardiac catheterization laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were overrepresented by people >65 years of age (32%) and indigenous people (60%).
Conclusions
The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and could be applied to other common disease states within other regions of the world.
Collapse
|
44
|
|
45
|
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58:e44-122. [PMID: 22070834 DOI: 10.1016/j.jacc.2011.08.007] [Citation(s) in RCA: 1719] [Impact Index Per Article: 132.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
46
|
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 894] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
47
|
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2011; 82:E266-355. [DOI: 10.1002/ccd.23390] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
48
|
What sustains long-term adherence to structured physical activity after a cardiac event? J Aging Phys Act 2011; 20:135-47. [PMID: 21949242 DOI: 10.1123/japa.20.2.135] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Research addressing methods to sustain long-term adherence to physical activity among older adults is needed. This study investigated the motivations and supports deemed necessary to adhere to a community-based cardiac rehabilitation (CBCR) program by individuals with established coronary heart disease. METHODS Twenty-four long-term adherers (15 men, 9 women; age 67.7 ± 16.7 yr) took part in focus-group discussions. RESULTS Constant comparative analysis supported previous research in terms of the importance of referral procedures, social support, and knowledge of health benefits in influencing uptake and adherence to CBCR. Results also highlighted the routine of a structured class and task-, barrier-, and recovery-specific self-efficacy as necessary to sustain long-term adherence for this specific clinical group. DISCUSSION Older adults themselves provide rich information on how to successfully support their long-term adherence to structured exercise sessions. Further research into how to build these components into any exercise program is necessary.
Collapse
|
49
|
Wittmer M, Volpatti M, Piazzalonga S, Hoffmann A. Expectation, satisfaction, and predictors of dropout in cardiac rehabilitation. Eur J Prev Cardiol 2011; 19:1082-8. [DOI: 10.1177/1741826711418163] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Melanie Wittmer
- Institute of Sports Sciences, University of Basel, Switzerland
| | | | | | | |
Collapse
|
50
|
Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Jneid H, Lincoff AM, Peterson ED, Philippides GJ, Theroux P, Wenger NK, Zidar JP, Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Zidar JP. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 57:e215-367. [PMID: 21545940 DOI: 10.1016/j.jacc.2011.02.011] [Citation(s) in RCA: 276] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|