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Redfern J, Gallagher R, Maiorana A, Candelaria D, Hollings M, Gauci S, O'Neil A, Chaseling GK, Zhang L, Thomas EE, Ghisi GLM, Gibson I, Hyun K, Beatty A, Briffa T, Taylor RS, Arena R, Jennings C, Wood D, Grace SL. Cardiac rehabilitation and secondary prevention of CVD: time to think about cardiovascular health rather than rehabilitation. NPJ CARDIOVASCULAR HEALTH 2024; 1:22. [PMID: 39359645 PMCID: PMC11442299 DOI: 10.1038/s44325-024-00017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/25/2024] [Indexed: 10/04/2024]
Abstract
During the past century, there have been major developments in the medical and surgical treatment of cardiovascular disease (CVD). These advancements have resulted in more people surviving initial events and having reduced length of stay in hospital; consequently, there is an increasing number of people in need of ongoing and lifelong cardiovascular risk management. The physical and emotional effects of living with CVD are ongoing with broad challenges ranging from the individual to system level. However, post-discharge care of people with coronary disease continues to follow a 50-year-old cardiac rehabilitation model which focuses on the sub-acute phase and is of a finite in duration. The aim of this paper is to consider the concept of supporting survivors to live well with CVD rather than 'rehabilitating' them and propose factors for consideration in reframing secondary prevention towards optimizing cardiovascular health. We discuss deeply-held potential considerations and challenges associated with the concept of supporting survivors achieve optimal cardiovascular health and live well with CVD rather than 'rehabilitating' them. We propose the concept of 5 x P's for reframing traditional cardiac rehabilitation towards the concept of cardiovascular health for survivors beyond 'rehabilitation'. These include the need for personalization, processes, patient-centered care, parlance, and partnership. Taken together, consideration of challenges at the systems and population level will ultimately improve engagement with secondary prevention as well as outcomes for all people who need it.
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Affiliation(s)
- Julie Redfern
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, NSW Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Andrew Maiorana
- Curtin School of Allied Health, Curtin University, Bentley, WA Australia
- Allied Health Department, Fiona Stanley Hospital, Murdoch, WA Australia
| | - Dion Candelaria
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Matthew Hollings
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Sarah Gauci
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC Australia
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC Australia
| | - Georgia K Chaseling
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Ling Zhang
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Emma E Thomas
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, QLD Australia
| | | | - Irene Gibson
- School of Medicine, University of Galway, Galway, Republic of Ireland
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
- Cardiology Department, Concord Hospital, ANZAC Research Institute, Concord, NSW Australia
| | - Alexis Beatty
- Alexis L Beatty, Departments of Epidemiology & Biostatistics and Medicine, University of California, California, USA
| | - Tom Briffa
- University of Western Australia, Crawley, WA Australia
| | - Rod S Taylor
- School of Health and Well Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland UK
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL USA
| | - Catriona Jennings
- National Institute for Prevention and Cardiovascular Health NIPC and University of Galway, Galway, Republic of Ireland
| | - David Wood
- National Institute for Prevention and Cardiovascular Health NIPC and University of Galway, Galway, Republic of Ireland
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON Canada
- KITE & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON Canada
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van den Houdt SCM, Wokke T, Mommersteeg PMC, Widdershoven J, Kupper N. The role of sex and gender in somatic complaints among patients with coronary heart disease: A longitudinal study on acute and long-term changes. J Psychosom Res 2024; 178:111601. [PMID: 38309128 DOI: 10.1016/j.jpsychores.2024.111601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Somatic complaints are persistently reported in patients with coronary heart disease (CHD). Sex and gender influence health and well-being in a variety of ways, but it is unknown how they affect somatic complaints over time after percutaneous coronary intervention (PCI). Therefore, we examined the association between sex and gender on somatic health complaints during the first month (acute) and the first two years (recovery) after PCI. METHODS 514 patients (Mage = 64.2 ± 8.9, 84.2% male) completed the somatic scale of the Health Complaints Scale (including the subscales: cardiopulmonary complaints, fatigue, sleep problems) at baseline, one, 12-, and 24-months post-PCI. In a follow-up study, they filled in additional questionnaires to gauge gender norms, traits, and identity. Linear mixed modeling analyses were used to assess the influence of sex, gender, their interaction, and covariates on somatic complaints for the acute and recovery phases separately. RESULTS A general decline in somatic complaints over time was observed during the acute phase, followed by a stabilization in the recovery phase. Females and individuals with more feminine traits, norms, and identities reported increased somatic complaints. Males with more pronounced feminine norms and females with more masculine norms likewise reported more somatic, cardiopulmonary, and fatigue complaints. Furthermore, age, cardiac history, and comorbid diseases partly explained the associations with somatic complaints. CONCLUSION While somatic complaints improve post-PCI, there are still conspicuous sex and gender differences that need to be considered. Future research should further elaborate upon these discrepancies and incorporate sex and gender in prevention and develop tailored interventions to diminish somatic complaints.
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Affiliation(s)
- Sophie C M van den Houdt
- Center of Research on Psychological disorders and Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO box 90153, 5000LE Tilburg, the Netherlands
| | - Tessa Wokke
- Center of Research on Psychological disorders and Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO box 90153, 5000LE Tilburg, the Netherlands
| | - Paula M C Mommersteeg
- Center of Research on Psychological disorders and Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO box 90153, 5000LE Tilburg, the Netherlands
| | - Jos Widdershoven
- Center of Research on Psychological disorders and Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO box 90153, 5000LE Tilburg, the Netherlands; Department of Cardiology, Elisabeth-TweeSteden hospital, Doctor Deelenlaan 5, 5042, AD, Tilburg, the Netherlands
| | - Nina Kupper
- Center of Research on Psychological disorders and Somatic diseases (CoRPS), Department of Medical & Clinical Psychology, Tilburg University, PO box 90153, 5000LE Tilburg, the Netherlands.
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Fatehi A, Brown LE, Versluijs Y, Van Maren K, Ring D, Gonzalez A, Ramtin S. The relationship of perceived empathy with levels of pain intensity and incapability among patients visiting a musculoskeletal specialist. PATIENT EDUCATION AND COUNSELING 2023; 115:107900. [PMID: 37467592 DOI: 10.1016/j.pec.2023.107900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND People that have more intense symptoms and greater incapability might have less rapport with the clinicians that care for them. OBJECTIVE This study tested the hypothesis that perceived clinician empathy is related to pain intensity and magnitude of incapability among people seeing a musculoskeletal specialist. PATIENT INVOLVEMENT After a consult with a musculoskeletal specialist, 211 adult patients completed a survey recording demographics, and measures of pain intensity, incapability, and perceived clinician empathy. RESULTS Higher perceived empathy was associated with being in a committed relationship and, to a modest degree (r = -0.16) lower pain intensity in bivariate and multivariable analyses. DISCUSSION People experiencing greater pain may be slightly less likely to perceive the clinician as empathetic. PRACTICAL VALUE Study of the relationship between the patient's experience of care and patient and clinician personal factors can inform efforts to improve patient experience. Advances may depend on experience measures with more normal distributions and less ceiling effect.
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Affiliation(s)
- Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Laura E Brown
- Center for Health Communication, Moody College of Communication, University of Texas at Austin, 300 W. Dean Keaton, Austin, TX 78712-1069, USA.
| | - Yvonne Versluijs
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Koen Van Maren
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Amanda Gonzalez
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
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Beatty AL, Beckie TM, Dodson J, Goldstein CM, Hughes JW, Kraus WE, Martin SS, Olson TP, Pack QR, Stolp H, Thomas RJ, Wu WC, Franklin BA. A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities. Circulation 2023; 147:254-266. [PMID: 36649394 PMCID: PMC9988237 DOI: 10.1161/circulationaha.122.061046] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.
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Affiliation(s)
- Alexis L Beatty
- Department of Epidemiology and Biostatistics (A.L.B.), University of California, San Francisco.,Department of Medicine, Division of Cardiology (A.L.B.), University of California, San Francisco
| | - Theresa M Beckie
- College of Nursing (T.M.B.), University of South Florida, Tampa.,College of Medicine, Division of Cardiovascular Sciences (T.M.B.), University of South Florida, Tampa
| | - John Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine (J.D.), New York University School of Medicine, New York.,Department of Population Health (J.D.), New York University School of Medicine, New York
| | - Carly M Goldstein
- The Weight Control and Diabetes Research Center, the Miriam Hospital, Providence, RI (C.M.G.).,Department of Psychiatry and Human Behavior, The Warren Alpert Medical School (C.M.G.), Brown University, Providence, RI
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, OH (J.W.H.)
| | - William E Kraus
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC (W.E.K.)
| | - Seth S Martin
- Department of Medicine, Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M.)
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield (Q.R.P.)
| | - Haley Stolp
- ASRT, Inc, Atlanta, GA (H.S.).,Centers for Disease Control and Prevention, Atlanta, GA (H.S.)
| | - Randal J Thomas
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Wen-Chih Wu
- Lifespan Cardiovascular Institute (W.-C.W.), Brown University, Providence, RI.,Division of Cardiology, Providence VA Medical Center, RI (W.-C.W.)
| | - Barry A Franklin
- William Beaumont Hospital, Royal Oak, MI (B.A.F.).,Oakland University William Beaumont School of Medicine, Rochester, MI (B.A.F.)
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Ghisi GLDM, Marzolini S, Price J, Beckie TM, Mamataz T, Naheed A, Grace SL. Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline. Can J Cardiol 2022; 38:1786-1798. [PMID: 36085185 DOI: 10.1016/j.cjca.2022.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/10/2022] [Accepted: 06/17/2022] [Indexed: 12/14/2022] Open
Abstract
Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and might result in better quality of life than traditional programs. This first clinical practice guideline by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The writing panel comprised experts with diverse geographic representation, including multidisciplinary health care providers, a policy-maker, and patient partners. The guideline was developed in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Reporting Items for practice Guidelines in HealTh care (RIGHT). Initial recommendations were on the basis of a meta-analysis. These were circulated to a Delphi panel (comprised of corresponding authors from review articles and of programs delivering women-focused CR identified through ICCPR's audit; N = 76), who were asked to rate each on a 7-point Likert scale in terms of impact and implementability (higher scores positive). A Web call was convened to achieve consensus; 15 panelists confirmed strength of revised recommendations (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review from CR societies internationally and was posted for public comment. The 14 drafted recommendations related to referral (systematic, encouragement), setting (model choice, privacy, staffing), and delivery (exercise mode, psychosocial, education, self-management empowerment). Nineteen (25.0%) survey responses were received. For all but 1 recommendation, ≥ 75% voted to include; implementability ratings were < 5/7 for 4 recommendations, but only 1 for effect. Ultimately 1 recommendation was excluded, 1 separated into 2 and all revised (2 substantively); 1 recommendation was added. Overall, certainty of evidence for the final recommendations was low to moderate, and strength mostly strong. These recommendations and associated tools can support all programs to feasibly offer some women-focused programming.
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Affiliation(s)
- Gabriela Lima de Melo Ghisi
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Susan Marzolini
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | | | - Theresa M Beckie
- College of Nursing, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA; College of Medicine, Division of Cardiovascular Sciences, University of South Florida, Tampa, Florida, USA
| | - Taslima Mamataz
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada
| | - Aliya Naheed
- Initiative for Non-Communicable Diseases, Health System and Population Studies Division, International Centre for Diarrheal Diseases Research Bangladesh, Dhaka, Bangladesh
| | - Sherry L Grace
- KITE-Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Health, York University, Toronto, Ontario, Canada; Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Pakrad F, Ahmadi F, Grace SL, Oshvandi K, Kazemnejad A. Traditional versus extended hybrid cardiac rehabilitation based on the continuous care model for coronary artery bypass surgery patients in a middle-income country: A Randomized Clinical Trial. Arch Phys Med Rehabil 2021; 102:2091-2101.e3. [PMID: 34175270 DOI: 10.1016/j.apmr.2021.04.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/23/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare traditional (1-month supervised) versus hybrid cardiac rehabilitation (CR; usual care) with an additional 3 months offered remotely based on the continuous care model (CCM; intervention), in coronary artery bypass graft (CABG) patients. DESIGN randomized controlled trial, with blinded outcome assessment. SETTING A major heart center in a middle-income country. PARTICIPANTS Of 107 eligible patients that were referred to CR during the period of study, 88 (82.2%) were enrolled (target sample size). Participants were randomly assigned 1:1 (concealed; 44 per parallel arm). There was 92.0% retention. INTERVENTION After CR, participants were given an app and communicated biweekly with the nurse from months 1-4 to control risk factors. MAIN OUTCOME MEASURES Quality of life (QoL; SF-36; primary outcome), functional capacity (treadmill test), depression, anxiety and stress (DASS-21) were evaluated pre-CR, after one month, and three months after CR (end of intervention), as well as re-hospitalization. RESULTS The analysis of variance interaction effects for the physical and mental component summary scores of QoL were <.001, favoring intervention (per protocol); there were also significant increases from pre-CR to 1 month, and from 1 month to the final assessment in the intervention arm (p-values<.001), with change in the control arm only to 1 month. The effect sizes were 0.115 and 0.248, respectively. Similarly, the interaction effect for functional capacity was significant (p<.001), with a clinically-significant 1.5 MET increase in the intervention arm. There were trends for group effects for the psychosocial indicators, with paired t-tests revealing significant increases in each at both assessment points in the intervention arm. At 4 months, there were 4 (10.3%) re-hospitalizations in the control arm, and none in intervention (p=.049). Intended theoretical mechanisms were also impacted by the intervention. CONCLUSION Extending CR in this accessible manner, rendering it more comprehensive, was effective in improving outcomes.
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Affiliation(s)
- Fatemeh Pakrad
- PhD Candidate of Nursing, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, Canada; KITE- Toronto Rehabilitation Institute, & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada
| | - Khodayar Oshvandi
- Department of Nursing, Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Ayton D, Soh SE, Morello R, Ahern S, Earnest A, Brennan A, Lefkovits J, Evans S, Reid C, Ruseckaite R, McNeil J. Development of a percutaneous coronary intervention patient level composite measure for a clinical quality registry. BMC Health Serv Res 2020; 20:44. [PMID: 31952535 PMCID: PMC6969470 DOI: 10.1186/s12913-019-4814-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/12/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Composite measures combine data to provide a comprehensive view of patient outcomes. Despite composite measures being a valuable tool to assess post-intervention outcomes, the patient perspective is often missing. The purpose of this study was to develop a composite measure for an established cardiac outcome registry, by combining clinical outcomes following percutaneous coronary interventions (PCI) with a patient-reported outcome measure (PROM) developed specifically for this population (MC-PROM). METHODS Two studies were undertaken. Study 1: Patients who had undergone a PCI at one of the three participating registry hospital sites completed the 5-item MC-PROM. Clinical outcome data for the patients (e.g. death, myocardial infarction, repeat vascularisation, new bleeding event) were collected 30 days post-intervention as part of routine data collection for the cardiac registry. Exploratory factor analysis of clinical outcomes and MC-PROM data was conducted to determine the minimum number of constructs to be included in a composite measure. Study 2: Clinical experts participated in a Delphi technique, consisting of three rounds of online surveys, to determine the clinical outcomes to be included and the weighting of the clinical outcomes and MC-PROM score for the composite measure. RESULTS Study 1: Routine clinical outcomes and the MC-PROM data were collected from 266 patients 30 days post PCI. The MC-PROM score was not significantly correlated with any clinical outcomes. Study 2: There was a relatively consistent approach to the weighting of the clinical outcomes and MC-PROM items by the expert panel (n = 18) across the three surveys with the exception of the clinical outcome of 'deceased at 30 days'. The final composite measure included five clinical outcomes within 30 days weighted at 90% (new heart failure, new myocardial infarction, new stent thrombosis, major bleeding event, new stroke, unplanned cardiac rehospitalisation) and the MC-PROM score (comprising 10% of the total weighting). CONCLUSIONS A single patient level composite score, which incorporates weighted clinical outcomes and a PROM was developed. This composite score provides a more comprehensive reported measure of individual patient wellbeing at 30 days post their PCI-procedure, and may assist clinicians to further assess and address patient level factors that potentially impact on clinical recovery.
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Affiliation(s)
- Darshini Ayton
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sze-Ee Soh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Physiotherapy, Monash University, Melbourne, Australia
| | - Renata Morello
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Susan Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- NHMRC Centre for Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Bentley, Western Australia Australia
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - John McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Mares MA, McNally S, Fernandez RS. Effectiveness of nurse-led cardiac rehabilitation programs following coronary artery bypass graft surgery: a systematic review. ACTA ACUST UNITED AC 2019; 16:2304-2329. [PMID: 30204710 DOI: 10.11124/jbisrir-2017-003565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW OBJECTIVE The objective of this review was to investigate the effectiveness of nurse-led cardiac rehabilitation programs following coronary artery bypass graft surgery on patients' health-related quality of life and hospital readmission. INTRODUCTION Coronary heart disease is a major cause of death and disability worldwide, putting a great strain on healthcare resources. For the past two decades, population-wide primary prevention and individual healthcare approaches have resulted in a dramatic decline in overall cardiac mortality. Over the intervening years, surgical techniques in cardiology have also improved substantially. As a result, long-term outcomes in patients treated with coronary artery bypass graft surgery have established the treatment's effectiveness and survival benefit. Furthermore, participating in cardiac rehabilitation following coronary artery bypass graft surgery has also demonstrated a significant decrease in all-cause cardiac mortality in these patients. INCLUSION CRITERIA This review included studies with participants aged 18 years and over, post coronary artery bypass graft surgery that evaluated nurse-led cardiac rehabilitation (CR) programs compared with usual care or other forms of CR. The outcomes of interest were the health-related quality of life and hospital readmissions following coronary artery bypass graft surgery and measured using validated scales. Randomized controlled trials reported in English between 2000 to June 2017 were considered for inclusion. METHODS The search strategy aimed to find both published and unpublished studies using a three-step search strategy. An initial search of MEDLINE, CINAHL and Scopus was undertaken, followed by a search for unpublished studies including Dissertation Abstracts International, ProQuest Dissertations and Theses, Google Scholar, MedNar and ClinicalTrials.gov. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal tools from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Quantitative data was extracted from papers included in the review using the standardized data extraction tool from JBI-SUMARI. No meta-analysis was undertaken due to heterogeneity of the outcome measures. All results were subject to double data entry. Effect sizes expressed as risk ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis. RESULTS Three trials involving 329 patients were included in the final review. The trials that investigated the effect of home based cardiac rehabilitation programs compared to usual care at six weeks, three months and six months follow-up demonstrated no statistically significant difference in health-related quality of life at any of the follow-up periods. However, one study demonstrated significantly higher scores related to health-related quality of life among those who received nurse-led home based cardiac rehabilitation (154.93 ± 4.6) compared to those who received usual care (134.20 ± 8.2) at two months follow-up. No trials were identified that compared the effectiveness of nurse-led cardiac rehabilitation programs following coronary artery bypass graft surgery on readmissions to hospital. CONCLUSION There is not enough evidence to support or discourage nurse-led cardiac rehabilitation programs on health-related quality of life in patients following coronary artery bypass graft surgery. However, the sparse data available suggests improvements in health-related quality of life at two months follow-up among those who received a nurse-led program. Further large-scale multicenter trials with standardized methodology are needed to determine the effect of nurse-led cardiac rehabilitation programs on health-related quality of life and rates of readmission to hospital following coronary artery bypass graft surgery.
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Affiliation(s)
- Maria A Mares
- School of Nursing and Midwifery, Western Sydney University, Parramatta, Australia.,Centre for Applied Nursing Research, Liverpool, Australia.,The New South Wales Centre for Evidence Based Health Care: a Joanna Briggs Institute Centre of Excellence.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Stephen McNally
- School of Nursing and Midwifery, Western Sydney University, Parramatta, Australia.,The New South Wales Centre for Evidence Based Health Care: a Joanna Briggs Institute Centre of Excellence
| | - Ritin S Fernandez
- School of Nursing, University of Wollongong, Wollongong, Australia.,Centre for Research in Nursing and Health, St George Hospital, Kogarah, Australia.,Centre for Evidence Based Initiatives in Health Care: a Joanna Briggs Institute Centre of Excellence
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Nosratabadi M, Halvaiepour Z. Development of a self-care program satisfaction questionnaire for cardiovascular patients in Iran. J Cardiovasc Thorac Res 2018; 10:24-27. [PMID: 29707174 PMCID: PMC5913689 DOI: 10.15171/jcvtr.2018.04] [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: 07/30/2017] [Accepted: 03/04/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction: Evaluating patient satisfaction with self-care program can increase the likelihood of complying with treatment. There is no valid and reliable tool to be used in measuring Iranian patient’s satisfaction with self-care program. So, this study intends to develop the patient satisfaction questionnaire in the context of cardiac rehabilitation and test its validity and reliability in Iranian patients.
Methods: A cross-sectional study was conducted to develop and validate the patient satisfaction with self-care program questionnaire using structural modeling. A total of 155 cardiovascular patients referring to cardiovascular rehabilitation center in Isfahan were participated in this study. Construct and criterion validity, and test-retest reliability were used to validate the scale.
Results:
After reviewing literature and receiving expert’ comments for items pooling as well as conducting exploratory factor analysis, 10 statements in the model remained which are loaded on 2 factors. These 2 subscales explained about 63 percent of variance of all constructs. The Cronbach’s alpha coefficient ranged between 0.87 and 0.89 for the whole questionnaires and its subscales. Besides, scale had excellent stability (intraclass correlation = 0.86). Criterion validity analyzed through correlational analyses revealed significant relationships between the current scale and Patient Satisfaction Questionnaire Short Form (PSQ11). CFA revealed an acceptable overall fit for two-factor model.
Conclusion: The scale integrated 10 items in two dimension including patient satisfaction with rehabilitation program and patient satisfaction with personnel of rehabilitation team. In total, most of the psychometric properties of the 10-item patient satisfaction with self-care program scale achieved the standard level and were sufficient to recommend for cardiac rehabilitation settings.
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Affiliation(s)
- Mehdi Nosratabadi
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zohreh Halvaiepour
- Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
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10
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Mosby DL, Manierre MJ, Martin SS, Kolm P, Abuzaid AS, Jurkovitz CT, Elliott DJ, Weintraub WS. Patient Satisfaction with Care After Coronary Revascularization. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 11:217-223. [PMID: 28875457 DOI: 10.1007/s40271-017-0274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Bridging the Divides (Bridges), a Centers for Medicare and Medicaid Services-funded program, developed a post-hospitalization care management infrastructure integrating information technology-enabled informatics with patient care for ischemic heart disease patients. The objective of this study was to assess patient satisfaction with the Bridges program and determine the patient characteristics associated with higher satisfaction. METHODS All adult English-speaking patients who underwent a percutaneous coronary intervention, coronary artery bypass grafting, or catheterization plus acute myocardial infarction and agreed to participate in the Bridges program were eligible. A survey instrument was administered to address patient satisfaction of care received, aspects of care that patients appreciated, and challenges faced. Descriptive statistics were calculated, and primary analyses included comparisons of overall patient satisfaction after discharge between procedure type, and according to age, sex, race, Elixhauser comorbidity count, and length of stay. RESULTS Four hundred and sixty-seven (46%) had complete or partial response rates. There was a statistically significant difference in the overall satisfaction among patients undergoing percutaneous coronary intervention, coronary artery bypass grafting, or catheterization plus acute myocardial infarction (p = 0.023). There were significant procedure by sex (p = 0.052) and procedure by age (p = 0.039) interactions. There were no statistically significant differences in overall satisfaction according to age, sex, race, comorbidity count, or length of stay. CONCLUSIONS This study identified several important components related to patient satisfaction for patients with ischemic heart disease. Results found that patients who underwent coronary artery bypass grafting were reportedly "very satisfied" when compared with patients who underwent percutaneous coronary intervention and catheterization plus acute myocardial infarction, as well as significant age and sex interactions between procedures.
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Affiliation(s)
- Danielle L Mosby
- National Center for Human Factors in Healthcare, Washington, DC, USA.
| | | | | | - Paul Kolm
- Value Institute, Christiana Care Health System, Newark, DE, USA
| | - A Sami Abuzaid
- Cardiology, Christiana Care Health System, Newark, Delaware, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Daniel J Elliott
- Christiana Care Quality Partners, Christiana Care Health System, Newark, DE, USA
| | - William S Weintraub
- Value Institute, Christiana Care Health System, Newark, DE, USA.,Christiana Care Health System, Newark, Delaware, USA
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11
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Ali S, Chessex C, Bassett-Gunter R, Grace SL. Patient satisfaction with cardiac rehabilitation: association with utilization, functional capacity, and heart-health behaviors. Patient Prefer Adherence 2017; 11:821-830. [PMID: 28479853 PMCID: PMC5411402 DOI: 10.2147/ppa.s120464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) societies recommend assessment of patient satisfaction given its association with health care utilization and outcomes. Recently, the Patient Assessment of Chronic Illness Care (PACIC, Glasgow) was recommended as an appropriate tool for the CR setting. The objectives of this study were to 1) describe patient satisfaction with CR, 2) test the psychometric properties of the PACIC in the CR setting, and 3) assess the association of patient satisfaction with CR utilization and outcomes. METHODS Secondary analysis was conducted on an observational, prospective CR program evaluation cohort. A convenience sample of patients from 1 of 3 CR programs was approached at their first CR visit, and consenting participants completed a survey. Clinical data were extracted from charts pre- and post-program. Participants were e-mailed surveys again 6 months (including the PACIC) and 1 and 2 years later. RESULTS Of 411 consenting patients, 247 (60.2%) completed CR. The mean PACIC score was 2.8±1.1/5. Internal reliability was α=0.95. The total PACIC score varied significantly by site (F=3.12, P=0.046), indicating discriminant validity. Patient satisfaction was significantly related to greater CR adherence (r=0.22, P<0.01) and completion (t=2.63, P<0.01), greater functional status at CR discharge (r=0.17, P=0.03) and 2 years post-intake (r=0.19, P=0.03), greater physical activity at discharge (r=0.18, P=0.02), as well as lower depressive symptoms at discharge (r=-0.16, P=0.02) and 1-year follow-up (r=-0.19, P=0.03). These associations sustained adjustment for sex. CONCLUSION Patients were relatively satisfied with their care. The PACIC is a psychometrically validated scale, which could serve as a useful tool to assess patient satisfaction with CR.
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Affiliation(s)
- Saba Ali
- School of Kinesiology and Health Science, York University
| | - Caroline Chessex
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Sherry L Grace
- School of Kinesiology and Health Science, York University
- Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, ON, Canada
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