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Su JJ, Wong AKC, He XF, Zhang LP, Cheng J, Lu LJ, Lan L, Wang Z, Lin RSY, Batalik L. Feasibility and effectiveness of cardiac telerehabilitation for older adults with coronary heart disease: A pilot randomized controlled trial. Contemp Clin Trials Commun 2024; 42:101365. [PMID: 39319320 PMCID: PMC11421251 DOI: 10.1016/j.conctc.2024.101365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/30/2024] [Accepted: 09/08/2024] [Indexed: 09/26/2024] Open
Abstract
Background Cardiac rehabilitation is a beneficial multidisciplinary treatment of exercise promotion, patient education, risk factor management, and psychosocial counseling for people with coronary heart disease (CHD) that is underutilized due to substantial disparities in access, referral, and participation. Empirical studies suggest that cardiac telerehabilitation (CTR) have safety and efficacy comparable to traditional in-person cardiac rehabilitation, however, older adults are under-reported with effectiveness, feasibility, and usability remains unclear. Methods The study randomized 43 older adults (84 % males) to the 12-week CTR intervention or standard of care. Guided by Social Cognitive Theory, participants received individualized in-person assessment and e-coaching sessions, followed by CTR usage at home. Data were collected at baseline (T0), six-week (T1), and 12-week (T2). Results Participants in the CTR intervention group showed significant improvement in daily steps (T1: β = 4126.58, p = 0.001; T2: β = 5285, p = 0.01) and health-promoting lifestyle profile (T1: β = 23.26, p < 0.001; T2: β = 12.18, p = 0.008) across study endpoints. Twenty participants completed the intervention, with 40 % used the website for data-uploading or experiential learning, 90 % used the pedometer for tele-monitoring. Improving awareness of rehabilitation and an action focus were considered key facilitators while physical discomforts and difficulties in using the technology were described as the main barriers. Conclusions The CTR is feasible, safe and effective in improving physical activity and healthy behaviors in older adults with CHD. Considering the variation in individual cardiovascular risk factors, full-scale RCT with a larger sample is needed to determine the effect of CTR on psychological symptoms, body weight and blood pressure, and quality of life.
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Affiliation(s)
| | | | - Xi-Fei He
- Department of Nursing, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, China
| | - Li-Ping Zhang
- Department of Nursing, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, China
| | - Jie Cheng
- Department of Nursing, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, China
| | - Li-Juan Lu
- Department of Nursing, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, China
| | - Lan Lan
- Department of Nursing, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, China
| | - Zhaozhao Wang
- Department of Nursing, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, China
| | - Rose S Y Lin
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, USA
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Mahdavi M, Thomas N, Flood C, Stewart-Lord A, Baillie L, Grisan E, Callaghan P, Panayotova R, Hothi SS, Griffith V, Jayadev S, Frings D. Evaluating artificial intelligence-driven stress echocardiography analysis system (EASE study): A mixed method study. BMJ Open 2024; 14:e079617. [PMID: 39357985 PMCID: PMC11448110 DOI: 10.1136/bmjopen-2023-079617] [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] [Indexed: 10/04/2024] Open
Abstract
INTRODUCTION The use and value of artificial intelligence (AI)-driven tools and techniques are under investigation in detecting coronary artery disease (CAD). EchoGo Pro is a patented AI-driven stress echocardiography analysis system produced by Ultromics Ltd. (henceforth Ultromics) to support clinicians in detecting cardiac ischaemia and potential CAD. This manuscript presents the research protocol for a field study to independently evaluate the accuracy, acceptability, implementation barriers, users' experience and willingness to pay, cost-effectiveness and value of EchoGo Pro. METHODS AND ANALYSIS The 'Evaluating AI-driven stress echocardiography analysis system' (EASE) study is a mixed-method evaluation, which will be conducted in five work packages (WPs). In WP1, we will examine the diagnostic accuracy by comparing test reports generated by EchoGo Pro and three manual raters. In WP2, we will focus on interviewing clinicians, innovation/transformation staff, and patients within the National Health Service (NHS), and staff within Ultromics, to assess the acceptability of this technology. In this WP, we will determine convergence and divergence between EchoGo Pro recommendations and cardiologists' interpretations and will assess what profile of cases is linked with convergence and divergence between EchoGo Pro recommendations and cardiologists' interpretations and how these link to outcomes. In WP4, we will conduct a quantitative cross-sectional survey of trust in AI tools applied to cardiac care settings among clinicians, healthcare commissioners and the general public. Lastly, in WP5, we will estimate the cost of deploying the EchoGo Pro technology, cost-effectiveness and willingness to pay cardiologists, healthcare commissioners and the general public. The results of this evaluation will support evidence-informed decision-making around the widespread adoption of EchoGo Pro and similar technologies in the NHS and other health systems. ETHICS APPROVAL AND DISSEMINATION This research has been approved by the NHS Health Research Authority (IRAS No: 315284) and the London South Bank University Ethics Panel (ETH2223-0164). Alongside journal publications, we will disseminate study methods and findings in conferences, seminars and social media. We will produce additional outputs in appropriate forms, for example, research summaries and policy briefs, for diverse audiences in NHS.
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Affiliation(s)
- Mahdi Mahdavi
- School of Applied Sciences, London South Bank University, London, UK
| | - Nicki Thomas
- Institute of Health and Social Care, London South Bank University, London, UK
| | - Chris Flood
- School of Health and Social Care, London South Bank University, London, UK
| | - Adele Stewart-Lord
- School of Allied and Community Health, London South Bank University, London, UK
| | - Lesley Baillie
- Department of Adult and Midwifery Studies, London South Bank University, London, UK
| | | | | | | | - Sandeep S Hothi
- Department of Cardiology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Virgil Griffith
- School of Applied Sciences, London South Bank University, London, UK
| | - Sharanya Jayadev
- School of Applied Sciences, London South Bank University, London, UK
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3
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Li R, Wang M, Chen S, Zhang L. Comparative efficacy and adherence of telehealth cardiac rehabilitation interventions for patients with cardiovascular disease: A systematic review and network meta-analysis. Int J Nurs Stud 2024; 158:104845. [PMID: 39032245 DOI: 10.1016/j.ijnurstu.2024.104845] [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: 12/08/2023] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Traditional center-based cardiac rehabilitation had low adherence rates. With the increasing utilization of digital technology in healthcare services, telehealth can overcome common barriers to improve adherence, and some telehealth interventions have been proven safe and effective. However, it remains unclear which telehealth intervention types can maximize the efficacy and adherence for cardiac rehabilitation. OBJECTIVE To compare the effect of different types of telehealth interventions on the efficacy and adherence of patients with cardiovascular disease in cardiac rehabilitation. DESIGN Systematic review and network meta-analysis. METHODS We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, ProQuest, Scopus, and Embase databases for randomized controlled trials of telehealth cardiac rehabilitation for cardiovascular disease patients from January 2013 to March 2024. The primary outcomes were peak oxygen uptake (VO2 peak) and adherence. Secondary outcomes included 6-minute walking distance, moderate-to-vigorous intensity physical activity, depression, self-reported quality of life, and patient satisfaction. The study protocol has been registered on PROSPERO (ID: CRD42023459643). RESULTS This network meta-analysis included 46 randomized controlled trials. The results indicated that telehealth cardiac rehabilitation improved VO2 peak, 6-minute walking distance, moderate-to-vigorous intensity physical activity, and adherence. The surface under the cumulative ranking curve (SUCRA) results showed that the Wearable Devices + Smartphone Applications (SUCRA = 86.8 %, mean rank = 1.7) was the most effective telehealth intervention for improving VO2 peak. The Smartphone Applications + Instant Communication Tools (SUCRA = 74.2 %, mean rank = 2.6) was the most effective telehealth intervention for promoting adherence. CONCLUSIONS Combining two or more types of telehealth interventions was found to be effective. Future efforts should prioritize conducting high-quality randomized controlled trials to identify more effective combinations with traditional cardiac rehabilitation.
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Affiliation(s)
- Ruru Li
- The First School of Medicine, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Miao Wang
- The School of Nursing, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Shuoshuo Chen
- The First School of Medicine, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Liqing Zhang
- The Department of Nursing, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China.
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Osailan AM. Cardiac Rehabilitation in Saudi Arabia: Current Status and Future Directions. Curr Cardiol Rep 2024; 26:1077-1083. [PMID: 39031281 DOI: 10.1007/s11886-024-02105-7] [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] [Accepted: 07/12/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE OF REVIEW Cardiovascular diseases (CVDs) are the leading cause of mortality in Saudi Arabia. Cardiac rehabilitation (CR) is one of the well-known interventions to control and minimize the burden of CVDs. Despite recommendations, CR utilization remains suboptimal in Saudi Arabia due to many reasons, including limited awareness, logistical barriers, shortage of specialized facilities and trained professionals, and perceptions about CVDs illness. This review is to evaluate the current status, effectiveness, accessibility, and challenges of CR utilization in Saudi Arabia, and to explore potential future directions for improving these services. The review addresses key questions regarding the incidence of CVDs, the characteristics of existing CR programs, barriers to CR access, and stakeholder perspectives. RECENT FINDINGS Recent studies demonstrate that the effectiveness of CR, particularly exercise training, in improving outcomes for post-coronary artery bypass grafting (CABG) patients is well-documented, though data on its impact on other cardiac conditions is limited. There are significant barriers to CR utilization in Saudi Arabia, including limited awareness, logistical challenges, a shortage of specialized facilities and trained professionals, and cultural perceptions about CVD. Stakeholder perspectives highlight the necessity for culturally sensitive and inclusive approaches, particularly in addressing gender-specific needs and enhancing patient-provider communication. The Saudi Vision 2030 presents opportunities to expand and enhance CR services in alignment with international standards. This review found that while CR is a crucial intervention for managing CVDs, its utilization in Saudi Arabia is suboptimal due to various barriers. To improve CR access and effectiveness, future strategies should focus on increasing public and professional awareness, developing infrastructure, training healthcare professionals, and fostering public-private partnerships. These measures are essential to making CR more accessible and tailored to the diverse needs of the Saudi population, ultimately enhancing the quality of cardiovascular care and patient outcomes in the region.
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Affiliation(s)
- Ahmad M Osailan
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia.
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5
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Rawstorn JC, Subedi N, Koorts H, Evans L, Cartledge S, Wallen MP, Grace FM, Islam SMS, Maddison R. Stakeholder perceptions of factors contributing to effective implementation of exercise cardiac telerehabilitation in clinical practice. Eur J Cardiovasc Nurs 2024:zvae127. [PMID: 39352400 DOI: 10.1093/eurjcn/zvae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/29/2024] [Accepted: 09/17/2024] [Indexed: 10/03/2024]
Abstract
AIMS Cardiac exercise telerehabilitation is effective and can be cost-effective for managing ischaemic heart disease, but implementation of evidence-based interventions in clinical practice remains a challenge. We aimed to identify factors that cardiac rehabilitation stakeholders perceived could influence the effectiveness of implementing an evidence-based, real-time remotely monitored cardiac exercise telerehabilitation intervention (REMOTE-CR). METHODS AND RESULTS Online interviews and focus groups were conducted with cardiac rehabilitation consumers (n = 16, 5 female, 61.1 ± 10.0 years), practitioners (n = 20, 14 female; 36.6 ± 11.8 years), and health service managers (n = 11, 7 female; 46.2 ± 9.2 years) recruited from one metropolitan and three inner-regional healthcare services in Western Victoria, Australia. Discussions were guided by two theoretical frameworks (Non-adoption, Abandonment, Scale-up, Spread, and Sustainability; Consolidated Framework for Implementation Research), and analysed thematically. Factors perceived to influence effective implementation of REMOTE-CR spanned all domains of the theoretical frameworks, related to six major themes (resources, change management, stakeholder targeting, knowledge, intervention design, security) and were largely consistent across study sites; however, the relative importance of each factor may vary between sites. CONCLUSION Effective implementation of exercise telerehabilitation interventions like REMOTE-CR will require a coordinated context-specific approach that considers factors across all levels of the healthcare system and implementation science frameworks. Key requirements include prioritizing resources, managing change, selecting target stakeholders, developing digital health capabilities, and selecting fit-for-purpose technologies that enable programme delivery objectives.
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Affiliation(s)
- Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Narayan Subedi
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Luke Evans
- Allied Health, Grampians Health, Ballarat, Australia
| | - Susie Cartledge
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew P Wallen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Institute of Health and Wellbeing, Federation University, Mt Helen, Australia
| | - Fergal M Grace
- Institute of Health and Wellbeing, Federation University, Mt Helen, Australia
- Future Regions Research Centre, Federation University, Mt Helen, Australia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
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Meredith SJ, Shepherd AI, Saynor ZL, Scott A, Gorczynski P, Perissiou M, Horne M, McNarry MA, Mackintosh KA, Witcher CSG. Device-based 24-hour movement behaviours in adult phase III cardiac rehabilitation service-users during the COVID-19 pandemic: a mixed-methods prospective observational study. Disabil Rehabil 2024:1-12. [PMID: 39257350 DOI: 10.1080/09638288.2024.2397086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/12/2024]
Abstract
PURPOSE To examine changes in device-based 24-hour movement behaviours (MB), and facilitators and barriers to physical activity (PA) and exercise, during remotely-delivered cardiac rehabilitation (RDCR). MATERIALS AND METHODS This prospective observational study used wrist-worn GENEActiv accelerometers to assess MB of 10 service-users (63 ± 10 years) at the start, middle, and end of three-months of RDCR. Barriers and facilitators to PA and exercise were explored through self-report diaries and analysed using content analysis. RESULTS At start, service-users were sedentary for 12.6 ± 0.7 h · day-1 and accumulated most PA at a light-intensity (133.52 ± 28.57 min · day-1) - neither changed significantly during RDCR. Sleep efficiency significantly reduced from start (88.80 ± 4.2%) to the end (86.1 ± 4.76%) of CR, with values meeting health-based recommendations (≥85%). Barriers to RDCR exercise included exertional discomfort and cardiac symptoms, and reduced confidence when exercising alone. Setting meaningful PA goals, self-monitoring health targets, and having social support, facilitated PA and exercise during RDCR. CONCLUSIONS Our RDCR programme failed to elicit significant changes in MB or sleep. To increase the likelihood of successful RDCR, it is important to promote a variety of exercise and PA options, target sedentary time, and apply theory to RDCR design, delivery, and support strategies.
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Affiliation(s)
- S J Meredith
- Academic Geriatric Medicine and National Institute of Health Research Collaboration for Leadership in Health Research and Care Wessex, University of Southampton, Southampton, UK
| | - A I Shepherd
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Z L Saynor
- School of Health Sciences, University of Southampton, Southampton, UK
| | - A Scott
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - P Gorczynski
- School of Human Sciences, University of Greenwich, London, UK
| | - M Perissiou
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - M Horne
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - M A McNarry
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Department of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - K A Mackintosh
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Department of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - C S G Witcher
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
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Igarashi T, Miyata K, Tamura S, Otani T, Iizuka T, Usuda S. Minimal clinically important difference in 6-minute walk distance estimated by multiple methods in inpatients with subacute cardiovascular disease. Physiother Theory Pract 2024; 40:1981-1989. [PMID: 37395670 DOI: 10.1080/09593985.2023.2232014] [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: 02/28/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Identifying the minimal clinically important difference (MCID) contributes to the ability to determine the efficacy of physiotherapy interventions and make good clinical decisions. PURPOSE The purpose of this study was to estimate the MCID for 6-minute walking distance (6MWD) among inpatients with subacute cardiac disease using multiple anchor-based methods. METHODS This study was a secondary data analysis using only data from a multicenter longitudinal observational study in which 6MWD was measured at two time points. Based on the changes in 6MWD between baseline measurement and follow-up approximately 1 week after baseline measurement, the global rating of change scales (GRCs) of patients and physiotherapists, anchor method receiver operator operating characteristic curves, predictive models, and adjusted models were used to calculate the MCID. RESULTS Participants comprised 35 patients. Mean (standard deviation) 6MWD was 228.9 m (121.1 m) at baseline and 270.1 m (125.0 m) at follow-up. MCID for each GRC was 27.5-35.6 m for patients and 32.5-38.6 m for physiotherapists. CONCLUSION The MCID in 6MWD in patients with subacute cardiovascular disease is 27.5-38.6 m. This value may be useful in determining the effectiveness of physiotherapy interventions and for decision-making.
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Affiliation(s)
- Tatsuya Igarashi
- Physical Therapy Division, Department of Rehabilitation, Numata Neurosurgery and Cardiovascular Hospital, Numata-Shi, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ami-Machi, Japan
| | - Shuntaro Tamura
- Department of Rehabilitation, Fujioka General Hospital, Fujioka-Shi, Gunma, Japan
| | - Tomohiro Otani
- Department of Physical Therapy, Ota College of Medical Technology, Ota-Shi, Gunma, Japan
| | - Takamitsu Iizuka
- Home-Visit Nursing Station COCO-LO Maebashi, Maebashi-Shi, Japan
| | - Shigeru Usuda
- Department of Rehabilitation Sciences, Gunma University Graduate School of Health Sciences, Showa-Machi, Japan
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Garofano M, Vecchione C, Calabrese M, Rusciano MR, Visco V, Granata G, Carrizzo A, Galasso G, Bramanti P, Corallo F, Izzo C, Ciccarelli M, Bramanti A. Technological Developments, Exercise Training Programs, and Clinical Outcomes in Cardiac Telerehabilitation in the Last Ten Years: A Systematic Review. Healthcare (Basel) 2024; 12:1534. [PMID: 39120237 PMCID: PMC11311841 DOI: 10.3390/healthcare12151534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/24/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are associated with very high rates of re-hospitalization and mortality worldwide, so the complexity of these pathologies requires frequent access to hospital facilities. The guidelines also emphasize the importance of cardiac rehabilitation (CR) programs, which have demonstrated a favorable effect on outcomes, and cardiac telerehabilitation (CTR) could represent an innovative healthcare delivery model. The aim of our review is to study how technologies used in rehabilitation have changed over time and also to understand what types of rehabilitation programs have been used in telerehabilitation. METHODS We searched randomized controlled trials (RCTs) in three electronic databases, PubMed, Web of Science, and Scopus, from January 2015 to January 2024, using relevant keywords. Initially, 502 articles were found, and 79 duplicates were identified and eliminated with EndNote. RESULTS In total, 16 RCTs fulfilled the pre-defined criteria, which were analyzed in our systematic review. The results showed that after CTR, there was a significant improvement in main outcome measures, as well as in relation to technological advances. CONCLUSIONS Moreover, compared to center-based rehabilitation, CTR can offer further advantages, with better cost-effectiveness, the breakdown of geographical barriers, and the improvement of access to treatment for the female population, which is traditionally more socially committed.
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Affiliation(s)
- Marina Garofano
- Department of Medicine, Surgery and Dentistry, University of Cagliari, 09124 Cagliari, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Mariaconsiglia Calabrese
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Maria Rosaria Rusciano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Valeria Visco
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Giovanni Granata
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Placido Bramanti
- Faculty of Psychology, University eCampus, 22060 Novedrate, Italy;
| | | | - Carmine Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
| | - Alessia Bramanti
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (C.V.); (M.C.); (M.R.R.); (V.V.); (G.G.); (A.C.); (G.G.); (C.I.); (M.C.); (A.B.)
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Bigot M, Guy JM, Monpere C, Cohen-Solal A, Pavy B, Iliou MC, Bosser G, Corone S, Douard H, Farrokhi T, Guerder A, Guillo P, Houppe JP, Pezel T, Pierre B, Roueff S, Thomas D, Verges B, Blanchard JC, Ghannem M, Marcadet D. Cardiac rehabilitation recommendations of the Group Exercise Rehabilitation Sports - Prevention (GERS-P) of the French Society of Cardiology: 2023 update. Arch Cardiovasc Dis 2024; 117:521-541. [PMID: 39174436 DOI: 10.1016/j.acvd.2024.05.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 08/24/2024]
Affiliation(s)
- Muriel Bigot
- Centre de réadaptation cardiaque, Cardiocéan, 17138 Puilboreau, France.
| | - Jean Michel Guy
- Le Clos Champirol rééducation, 42270 Saint-Priest-en-Jarez, France
| | | | - Alain Cohen-Solal
- Service de cardiologie, centre de réadaptation cardiaque, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, Inserm UMRS-942, université Paris Cité, 75010 Paris, France
| | - Bruno Pavy
- Service de réadaptation cardiovasculaire, CH Loire Vendée Océan, 44270 Machecoul, France
| | - Marie Christine Iliou
- Centre de réadaptation cardiaque, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - Gilles Bosser
- Service de cardiologie pédiatrique et congénitale, CHU Nancy, 54600 Vandœuvre-Lès-Nancy, France
| | - Sonia Corone
- Service réadaptation cardiaque, centre hospitalier de Bligny, 91640 Briis-sous-Forges, France
| | | | - Titi Farrokhi
- Service réadaptation cardiaque, centre hospitalier de Bligny, 91640 Briis-sous-Forges, France
| | - Antoine Guerder
- Service de pneumologie, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - Pascal Guillo
- Centre de réadaptation Saint-Yves, 35000 Rennes, France
| | | | - Theo Pezel
- Service de cardiologie, hôpital Lariboisière, AP-HP, université Paris Est Créteil, 75010 Paris, France
| | | | - Stephane Roueff
- Service de néphrologie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - Daniel Thomas
- Institut de cardiologie Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | | | | | - Mohamed Ghannem
- Service de cardiologie, hôpital de Gonesse, faculté de médecine, Sousse, Tunisia; Université Picardie Jules-Verne, 80000 Amiens, France
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10
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Bernier J, Breton M, Poitras ME. Co-designing a cardiac rehabilitation program with knowledge users for patients with cardiovascular disease from a remote area. BMC Health Serv Res 2024; 24:869. [PMID: 39085825 PMCID: PMC11290167 DOI: 10.1186/s12913-024-11321-4] [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: 02/21/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death worldwide. Cardiac rehabilitation (CR) programs are recognized as effective in reducing the burden of cardiovascular disease. However, CR programs are offered inequitably across regions and are available in less than 15% of remote areas worldwide. The main goal of this study was to design a CR program adapted to the contexts of remote areas to improve the service offered to patients. METHODS We used an iterative user-centered design approach to understand the user context and services offered in cardiac rehabilitation in remote areas. We conducted two co-design processes with knowledge users in two remote regions. Two advisory committees were created in each of these regions, comprising managers (n = 6), healthcare professionals (n = 12) and patients (n = 2). We utilized the BACPR guidelines and the Hautes Autorités de santé operational model to support data collection in coding sessions to develop the CR program. We conducted four cycles of co-design with each of the committees to develop the cardiac rehabilitation program. Qualitative data were analyzed iteratively after each cycle. RESULTS The co-design process resulted in developing a prototype cardiac rehabilitation program similar in both regions. It is based on a contextualized six-phase pathway of care designed for remote regions. For each phase 0 to 6 of the care pathway, knowledge users were asked to describe how to offer these phases in remote areas. Participants made structural changes to phases 0, 2, 3 and 4 in order to overcome staffing shortages in remote areas. These changes make it possible to decentralize cardiac rehabilitation expertise away from specialized centers, to ensure equity of service across the territory. Therapeutic patient education was integrated into phase 4 to meet patients' needs. Participants suggested that three follow-up offerings could come from nursing services to increase access to the cardiac rehabilitation program (primary care, home care, special chronic disease programs) in patients' home communities. CONCLUSION The co-design process enables us to meet the needs of remote regions in program development. This final program can be the subject of future implementation research.
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Affiliation(s)
- Jessica Bernier
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Saguenay-Lac-St-Jean, 305, Saint-Vallier, Chicoutimi, Québec, G7H 5H6, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Canada Research Chair in Clinical Governance on Primary Health Care, Université de Sherbrooke, 150 Pl. Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, Saguenay-Lac-St-Jean, 305, Saint-Vallier, Chicoutimi, Québec, G7H 5H6, Canada.
- CRMUS Research Chair On Optimal Professional Practices in Primary Care, Centre Intégré Universitaire de Santé et de Services sociaux du, Saguenay-Lac-St-Jean, Saguenay, Canada.
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El-Deyarbi M, Ahmed LA, King J, Al Nuaimi H, Al Juboori A, Mansour NA, Jarab AS, Abdel-Qader DH, Aburuz S. Effect of structured diet with exercise education on anthropometry and lifestyle modification in patients with type 2 diabetes: A 12-month randomized clinical trial. Diabetes Res Clin Pract 2024; 213:111754. [PMID: 38906331 DOI: 10.1016/j.diabres.2024.111754] [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: 02/19/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Abstract
AIMS Lifestyle modification involving active engagement of specialised dietitian with diet and exercise education, can be effective as first-line treatment for diabetes. METHODS 192 patients were enrolled with diabetes in a randomised controlled trial and followed up for one year. Ninety-four patients in the intervention group participated in a comprehensive structured diet and exercise education conducted by a specialised dietitian at ambulatory centre in the United Arab Emirates. RESULTS The mean difference in the change in body mass index between study groups at study exit and baseline was statistically significant (BMI difference = -1.86, 95 % CI -2.68 - -1.04, P < 0.01). The intervention group reported significant decrease in total carbohydrate and daily energy intake compared to baseline (173.7 g vs 221.1 g and 1828.5 kcal vs 2177.9 kcal, respectively). Moreover, the mean metabolic equivalents (METs) in the intervention group increased significantly at study exit from baseline compared to control group METs, with mean difference between all between-group differences after baseline of 0.63 (95 % 0.29 - 0.97, P < 0.01). CONCLUSIONS Structured diet and exercise counselling by specialised dietitian in ambulatory settings significantly reduced carbohydrate and daily energy intake, with improved anthropometric measurements and physical activity.
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Affiliation(s)
- Marwan El-Deyarbi
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; Department of Pharmacy, Oud Al-Touba Diagnostic and Screening Clinic, Ambulatory Health Services, Abu Dhabi Health Services Co. (SEHA), Al Ain, United Arab Emirates
| | - Luai A Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Jeffrey King
- David Geffen School of Medicine at the University of California, Los Angeles, CA USA; Department of Veterans Affairs, Greater Los Angeles, Department of Geriatrics and Extended Care, Los Angeles, CA USA
| | - Huda Al Nuaimi
- Clinical Nutrition and Dietary Department, Oud Al-Touba Diagnostic and Screening Clinic, Ambulatory Health Services, Abu Dhabi Health Services Co. (SEHA), Al Ain, United Arab Emirates
| | - Ahmed Al Juboori
- Division of Endocrinology, Oud Al-Touba Diagnostic and Screening Clinic, Ambulatory Health Services, Abu Dhabi Health Services Co. (SEHA), Al Ain, United Arab Emirates
| | - Nirmin A Mansour
- Division of Endocrinology, Oud Al-Touba Diagnostic and Screening Clinic, Ambulatory Health Services, Abu Dhabi Health Services Co. (SEHA), Al Ain, United Arab Emirates
| | - Anan S Jarab
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates; Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Salahdein Aburuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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Guan Z, Zhang X, Jin Y, Qiu R, Shang H. Development of a core outcome set for cardiac rehabilitation in patients with myocardial infarction: a study protocol. BMJ Open 2024; 14:e083633. [PMID: 38858159 PMCID: PMC11168154 DOI: 10.1136/bmjopen-2023-083633] [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] [Received: 12/23/2023] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Heterogeneous outcome reporting is common in clinical trials focused on cardiac rehabilitation for myocardial infarction (MI); this practice often results in the exclusion of data from clinical trials in systematic reviews. Developing a core outcome set (COS) may solve this problem. METHODS AND ANALYSIS We will first identify a preliminary list of outcomes through a systematic review. Next, we will conduct semistructured interviews with patients to explore additional potential outcomes deemed important by patients. Then, we will engage various stakeholders such as clinicians, researchers and methodologists in two Delphi survey tends to refine and prioritise the identified outcomes. Subsequently, we will gather insights directly from patients with MI by administering plain language patient surveys; patients will be involved in questionnaire development. Finally, we will hold two face-to-face consensus meetings for patients and other stakeholders to develop the final COS for cardiac rehabilitation in MI. ETHICS AND DISSEMINATION The Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine approved this study (2022DZMEC-349). The final COS will be published in a peer-reviewed journal and disseminated in conferences. TRIAL REGISTRATION We registered this study in the Core Outcome Measures in Effectiveness Trials Initiative (COMET) platform. REGISTRATION NUMBER 1725 (http://www.comet-initiative.org/studies/details/1725).
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Affiliation(s)
- Zhiyue Guan
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xinyi Zhang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, wuhan daxue zhongnan yiyuan, Wuhan, Hubei, China
| | - Ruijin Qiu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- University of Liverpool, Liverpool, UK
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Buckley BJR, Kerstens TP, France-Ratcliffe M, Lip GY, Thijssen DHJ. Cardiac rehabilitation and adverse events among adult patients with simple congenital heart disease and heart failure. Am J Prev Cardiol 2024; 18:100677. [PMID: 38764779 PMCID: PMC11101941 DOI: 10.1016/j.ajpc.2024.100677] [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: 09/26/2023] [Revised: 04/17/2024] [Accepted: 04/27/2024] [Indexed: 05/21/2024] Open
Abstract
Aims Improved care has resulted in prolonged survival of patients with congenital heart disease (ConHD), increasing age-related cardiovascular comorbidities. Although cardiovascular rehabilitation (CR) represents evidence-based care for heart failure (HF), the clinical impact of CR in patients with ConHD who developed HF during adulthood is unclear. We investigated 12-month mortality and morbidity in patients with simple ConHD diagnosed with HF with CR versus without CR. Methods A retrospective cohort study was conducted for the time period February 2004 - February 2024. Utilizing TriNetX, a global federated health research network, a real-world dataset of simple ConHD patients was acquired to compare patients with vs. without (controls) prescription for exercise-based CR. Patients were propensity-score matched for age, sex, ethnicity, comorbidities, procedures, and medication. The primary outcome was a composite of all-cause mortality, ischemic stroke, and acute coronary syndrome (major adverse cardiovascular events; MACE) within 12 months. Results Following propensity score matching, the total cohort consisted of 6,866 simple ConHD patients with HF. CR was associated with significantly lower odds for MACE (odds ratio (OR) 0.61 [95 % confidence interval (CI): 0.54-0.69]) and its individual components all-cause mortality (OR 0.40 [95 % CI 0.33-0.47]) and ischemic stroke (OR 0.75 [95 % CI 0.64-0.88]), but not acute coronary syndrome (OR 1.24 [95 % CI 0.91-1.69]). Conclusion CR was associated with significantly lower 12-month MACE in patients with simple ConHD with concomitant HF compared to usual care.
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Affiliation(s)
- Benjamin JR Buckley
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom
| | - Thijs P. Kerstens
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Madeleine France-Ratcliffe
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dick HJ Thijssen
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 5UX, United Kingdom
- Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
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14
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Batalik L, Chamradova K, Winnige P, Dosbaba F, Batalikova K, Vlazna D, Janikova A, Pepera G, Abu-Odah H, Su JJ. Effect of exercise-based cancer rehabilitation via telehealth: a systematic review and meta-analysis. BMC Cancer 2024; 24:600. [PMID: 38760805 PMCID: PMC11100177 DOI: 10.1186/s12885-024-12348-w] [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: 02/21/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
PURPOSE Exercise-based cancer rehabilitation via digital technologies can provide a promising alternative to centre-based exercise training, but data for cancer patients and survivors are limited. We conducted a meta-analysis examining the effect of telehealth exercise-based cancer rehabilitation in cancer survivors on cardiorespiratory fitness, physical activity, muscle strength, health-related quality of life, and self-reported symptoms. METHODS PubMed, Web of Science, and reference lists of articles related to the aim were searched up to March 2023. Randomized controlled clinical trials were included comparing the effect of telehealth exercise-based cancer rehabilitation with guideline-based usual care in adult cancer survivors. The primary result was cardiorespiratory fitness expressed by peak oxygen consumption. RESULTS A total of 1510 participants were identified, and ten randomized controlled trials (n = 855) were included in the meta-analysis. The study sample was 85% female, and the mean age was 52.7 years. Meta-analysis indicated that telehealth exercise-based cancer rehabilitation significantly improved cardiorespiratory fitness (SMD = 0.34, 95% CI 0.20, 0.49, I2 = 42%, p < 0.001) and physical activity (SMD = 0.34, 95% CI, 0.17, 0.51, I2 = 71%, p < 0.001). It was uncertain whether telehealth exercise-based cancer rehabilitation, compared with guideline-based usual care, improved the quality of life (SMD = 0.23, 95%CI, -0.07, 0.52, I2 = 67%, p = 0.14) body mass index (MD = 0.46, 95% CI, -1.19, 2.12, I2 = 60%, p = 0.58) and muscle strength (SMD = 0.07, 95% CI, -0.14, 0.28, I2 = 37%, p = 0.51). CONCLUSION This meta-analysis showed that telehealth exercise cancer rehabilitation could significantly increase cardiorespiratory fitness and physical activity levels and decrease fatigue. It is uncertain whether these interventions improve quality of life and muscle strength. High-quality and robust studies are needed to investigate specific home-based exercise regimens in different cancer subgroups to increase the certainty of the evidence.
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Affiliation(s)
- Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic.
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Katerina Chamradova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Petr Winnige
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Katerina Batalikova
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Daniela Vlazna
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurology, Center for Neuromuscular Diseases (Associated National Center in the European Reference Network ERN EURO-NMD), University Hospital Brno, Brno, Czech Republic
| | - Andrea Janikova
- Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Research Laboratory Department of Physiotherapy, Faculty of Health Sciences, University of Thessaly, Lamia, Greece
| | - Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jing Jing Su
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China.
- School of Nursing, Tung Wah College, Hong Kong, China.
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15
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Gallegos-Rejas VM, Rawstorn JC, Gallagher R, Mahoney R, Thomas EE. Key features in telehealth-delivered cardiac rehabilitation required to optimize cardiovascular health in coronary heart disease: a systematic review and realist synthesis. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:208-218. [PMID: 38774382 PMCID: PMC11104477 DOI: 10.1093/ehjdh/ztad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 05/24/2024]
Abstract
Telehealth-delivered cardiac rehabilitation (CR) programmes can potentially increase participation rates while delivering equivalent outcomes to facility-based programmes. However, key components of these interventions that reduce cardiovascular risk factors are not yet distinguished. This study aims to identify features of telehealth-delivered CR that improve secondary prevention outcomes, exercise capacity, participation, and participant satisfaction and develop recommendations for future telehealth-delivered CR. The protocol for our review was registered with the Prospective Register of Systematic Reviews (#CRD42021236471). We systematically searched four databases (PubMed, Scopus, EMBASE, and Cochrane Database) for randomized controlled trials comparing telehealth-delivered CR programmes to facility-based interventions or usual care. Two independent reviewers screened the abstracts and then full texts. Using a qualitative review methodology (realist synthesis), included articles were evaluated to determine contextual factors and potential mechanisms that impacted cardiovascular risk factors, exercise capacity, participation in the intervention, and increased satisfaction. We included 37 reports describing 26 randomized controlled trials published from 2010 to 2022. Studies were primarily conducted in Europe and Australia/Asia. Identified contextual factors and mechanisms were synthesized into four theories required to enhance participant outcomes and participation. These theories are as follows: (i) early and regular engagement; (ii) personalized interventions and shared goals; (iii) usable, accessible, and supported interventions; and (iv) exercise that is measured and monitored. Providing a personalized approach with frequent opportunities for bi-directional interaction was a critical feature for success across telehealth-delivered CR trials. Real-world effectiveness studies are now needed to complement our findings.
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Affiliation(s)
- Victor M Gallegos-Rejas
- Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Western Ave, Camperdown, NSW 2050, Australia
| | - Ray Mahoney
- CSIRO Health & Biosecurity, Australian e-Health Research Centre, Surgical, Treatment and Rehabilitation Service—STARS Level 7, 296 Herston Rd, Herston 4029, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Ground Floor Building 33, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
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Beverly EA, Koopman-Gonzalez S, Wright J, Dungan K, Pallerla H, Gubitosi-Klug R, Baughman K, Konstan MW, Bolen SD. Assessing Priorities in a Statewide Cardiovascular and Diabetes Health Collaborative Based on the Results of a Needs Assessment: Cross-Sectional Survey Study. JMIR Form Res 2024; 8:e55285. [PMID: 38607661 PMCID: PMC11053386 DOI: 10.2196/55285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites general and subspecialty medical staff at the 7 medical schools in Ohio with community and public health partnerships to improve cardiovascular and diabetes health outcomes and eliminate disparities in Ohio's Medicaid population. Although statewide collaboratives exist to address health improvements, few deploy needs assessments to inform their work. OBJECTIVE Cardi-OH conducts an annual needs assessment to identify high-priority clinical topics, screening practices, policy changes for home monitoring devices and referrals, and preferences for the dissemination and implementation of evidence-based best practices. The results of the statewide needs assessment could also be used by others interested in disseminating best practices to primary care teams. METHODS A cross-sectional survey was distributed electronically via REDCap (Research Electronic Data Capture; Vanderbilt University) to both Cardi-OH grant-funded and non-grant-funded members (ie, people who have engaged with Cardi-OH but are not funded by the grant). RESULTS In total, 88% (103/117) of Cardi-OH grant-funded members and 8.14% (98/1204) of non-grant-funded members completed the needs assessment survey. Of these, 51.5% (53/103) of Cardi-OH grant-funded members and 47% (46/98) of non-grant-funded members provided direct clinical care. The top cardiovascular medicine and diabetes clinical topics for Cardi-OH grant-funded members (clinical and nonclinical) were lifestyle prescriptions (50/103, 48.5%), atypical diabetes (38/103, 36.9%), COVID-19 and cardiovascular disease (CVD; 38/103, 36.9%), and mental health and CVD (38/103, 36.9%). For non-grant-funded members, the top topics were lifestyle prescriptions (53/98, 54%), mental health and CVD (39/98, 40%), alcohol and CVD (27/98, 28%), and cardiovascular complications (27/98, 28%). Regarding social determinants of health, Cardi-OH grant-funded members prioritized 3 topics: weight bias and stigma (44/103, 42.7%), family-focused interventions (40/103, 38.8%), and adverse childhood events (37/103, 35.9%). Non-grant-funded members' choices were family-focused interventions (51/98, 52%), implicit bias (43/98, 44%), and adverse childhood events (39/98, 40%). Assessment of other risk factors for CVD and diabetes across grant- and non-grant-funded members revealed screening for social determinants of health in approximately 50% of patients in each practice, whereas some frequency of depression and substance abuse screening occurred in 80% to 90% of the patients. Access to best practice home monitoring devices was challenging, with 30% (16/53) and 41% (19/46) of clinical grant-funded and non-grant-funded members reporting challenges in obtaining home blood pressure monitoring devices and 68% (36/53) and 43% (20/46) reporting challenges with continuous glucose monitors. CONCLUSIONS Cardi-OH grant- and non-grant-funded members shared the following high-priority topics: lifestyle prescriptions, CVD and mental health, family-focused interventions, alcohol and CVD, and adverse childhood experiences. Identifying high-priority educational topics and preferred delivery modalities for evidence-based materials is essential for ensuring that the dissemination of resources is practical and useful for providers.
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Affiliation(s)
- Elizabeth A Beverly
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, United States
| | | | - Jackson Wright
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Kathleen Dungan
- Department of Medicine, Ohio State University College of Medicine, Columbus, OH, United States
| | - Harini Pallerla
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Rose Gubitosi-Klug
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Kristin Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, United States
| | - Michael W Konstan
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Shari D Bolen
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
- Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, OH, United States
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17
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Simpson SA, Evans RA, Gilbert HR, Branson A, Barber S, McIntosh E, Ahmed Z, Dean SG, Doherty PJ, Gardiner N, Greaves C, Daw P, Ibbotson T, Jani B, Jolly K, Mair F, Ormandy P, Smith S, Singh SJ, Taylor R. Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (PERFORM): protocol for a randomised feasibility trial. BMJ Open 2024; 14:e083255. [PMID: 38580370 PMCID: PMC11002422 DOI: 10.1136/bmjopen-2023-083255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/18/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (PERFORM) is a research programme that seeks to develop and evaluate a comprehensive exercise-based rehabilitation intervention designed for people with multimorbidity, the presence of multiple long-term conditions (MLTCs). This paper describes the protocol for a randomised trial to assess the feasibility and acceptability of the PERFORM intervention, study design and processes. METHODS AND ANALYSIS A multicentre, parallel two-group randomised trial with individual 2:1 allocation to the PERFORM exercise-based intervention plus usual care (intervention) or usual care alone (control). The primary outcome of this feasibility trial will be to assess whether prespecified progression criteria (recruitment, retention, intervention adherence) are met to progress to the full randomised trial. The trial will be conducted across three UK sites and 60 people with MLTCs, defined as two or more LTCs, with at least one having evidence of the beneficial effect of exercise. The PERFORM intervention comprises an 8-week (twice a week for 6 weeks and once a week for 2 weeks) supervised rehabilitation programme of personalised exercise training and self-management education delivered by trained healthcare professionals followed by two maintenance sessions. Trial participants will be recruited over a 4.5-month period, and outcomes assessed at baseline (prerandomisation) and 3 months postrandomisation and include health-related quality of life, psychological well-being, symptom burden, frailty, exercise capacity, physical activity, sleep, cognition and serious adverse events. A mixed-methods process evaluation will assess acceptability, feasibility and fidelity of intervention delivery and feasibility of trial processes. An economic evaluation will assess the feasibility of data collection and estimate the costs of the PERFORM intervention. ETHICS AND DISSEMINATION The trial has been given favourable opinion by the West Midlands, Edgbaston Research Ethics Service (Ref: 23/WM/0057). Participants will be asked to give full, written consent to take part by trained researchers. Findings will be disseminated via journals, presentations and targeted communications to clinicians, commissioners, service users and patients and the public. TRIAL REGISTRATION NUMBER ISRCTN68786622. PROTOCOL VERSION 2.0 (16 May 2023).
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Affiliation(s)
- Sharon Anne Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | | | - Amy Branson
- Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Shaun Barber
- Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment (HEHTA), University of Glasgow Institute of Health and Wellbeing, Glasgow, UK
| | - Zahira Ahmed
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, UK
| | | | | | - Nikki Gardiner
- Department of Cardiopulmonary Rehabilitation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Science, University of Birmingham, Birmingham, UK
| | - Paulina Daw
- School of Sport, Exercise and Rehabilitation Science, University of Birmingham, Birmingham, UK
| | - Tracy Ibbotson
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Bhautesh Jani
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Frances Mair
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Paula Ormandy
- University of Salford School of Nursing Midwifery and Social Work, Manchester, UK
| | - Susan Smith
- Community Health and General Practice, Trinity College Dublin, Dublin, Ireland
| | - Sally J Singh
- Cardiac/Pulmonary Rehabilitation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rod Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
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Albustami M, Hartfiel N, Charles JM, Powell R, Begg B, Birkett ST, Nichols S, Ennis S, Hee SW, Banerjee P, Ingle L, Shave R, McGregor G, Edwards RT. Cost-effectiveness of High-Intensity Interval Training (HIIT) vs Moderate Intensity Steady-State (MISS) Training in UK Cardiac Rehabilitation. Arch Phys Med Rehabil 2024; 105:639-646. [PMID: 37730193 DOI: 10.1016/j.apmr.2023.09.005] [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: 04/28/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To perform a cost-effectiveness analysis of high-intensity interval training (HIIT) compared with moderate intensity steady-state (MISS) training in people with coronary artery disease (CAD) attending cardiac rehabilitation (CR). DESIGN Secondary cost-effectiveness analysis of a prospective, assessor-blind, parallel group, multi-center RCT. SETTING Six outpatient National Health Service cardiac rehabilitation centers in England and Wales, UK. PARTICIPANTS 382 participants with CAD (N=382). INTERVENTIONS Participants were randomized to twice-weekly usual care (n=195) or HIIT (n=187) for 8 weeks. Usual care was moderate intensity continuous exercise (60%-80% maximum capacity, MISS), while HIIT consisted of 10 × 1-minute intervals of vigorous exercise (>85% maximum capacity) interspersed with 1-minute periods of recovery. MAIN OUTCOME MEASURES We conducted a cost-effectiveness analysis of the HIIT or MISS UK trial. Health related quality of life was measured with the EQ-5D-5L to estimate quality-adjusted life years (QALYs). Costs were estimated with health service resource use and intervention delivery costs. Cost-utility analysis measured the incremental cost-effectiveness ratio (ICER). Bootstrapping assessed the probability of HIIT being cost-effective according to the UK National Institute for Health and Care Excellence (NICE) threshold value (£20,000 per QALY). Missing data were imputed. Uncertainty was estimated using probabilistic sensitivity analysis. Assumptions were tested using univariate/1-way sensitivity analysis. RESULTS 124 (HIIT, n=59; MISS, n=65) participants completed questionnaires at baseline, 8 weeks, and 12 months. Mean combined health care use and delivery cost was £676 per participant for HIIT, and £653 for MISS. QALY changes were 0.003 and -0.013, respectively. For complete cases, the ICER was £1448 per QALY for HIIT compared with MISS. At a willingness-to-pay threshold of £20,000 per QALY, the probability of HIIT being cost-effective was 96% (95% CI, 0.90 to 0.95). CONCLUSION For people with CAD attending CR, HIIT was cost-effective compared with MISS. These findings are important to policy makers, commissioners, and service providers across the health care sector.
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Affiliation(s)
- Mohammed Albustami
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Ned Hartfiel
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Joanna M Charles
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Richard Powell
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Centre for Sport Exercise & Life Sciences, Institute of Health & Well-being, Coventry University, UK
| | - Brian Begg
- Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, Wales UK; Aneurin Bevan University Health Board, Gwent, Wales, UK
| | - Stefan T Birkett
- Department of Sport and Exercise Sciences. Manchester Metropolitan University, Manchester, UK
| | - Simon Nichols
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK; Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Stuart Ennis
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Siew Wan Hee
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Prithwish Banerjee
- Centre for Sport Exercise & Life Sciences, Institute of Health & Well-being, Coventry University, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK; Department of Cardiology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Lee Ingle
- Department of Sport, Health & Exercise Science, University of Hull, Hull, UK
| | - Rob Shave
- Centre for Heart Lung and Vascular Health, University of British Columbia, Okanagan, Canada
| | - Gordon McGregor
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK; Centre for Sport Exercise & Life Sciences, Institute of Health & Well-being, Coventry University, UK; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.
| | - Rhiannon T Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
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Molloy C, Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, Coats AJ, Dalal H, Rees K, Singh SJ, Taylor RS. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database Syst Rev 2024; 3:CD003331. [PMID: 38451843 PMCID: PMC10919451 DOI: 10.1002/14651858.cd003331.pub6] [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] [Indexed: 03/09/2024]
Abstract
BACKGROUND People with heart failure experience substantial disease burden that includes low exercise tolerance, poor health-related quality of life (HRQoL), increased risk of mortality and hospital admission, and high healthcare costs. The previous 2018 Cochrane review reported that exercise-based cardiac rehabilitation (ExCR) compared to no exercise control shows improvement in HRQoL and hospital admission amongst people with heart failure, as well as possible reduction in mortality over the longer term, and that these reductions appear to be consistent across patient and programme characteristics. Limitations noted by the authors of this previous Cochrane review include the following: (1) most trials were undertaken in patients with heart failure with reduced (< 45%) ejection fraction (HFrEF), and women, older people, and those with heart failure with preserved (≥ 45%) ejection fraction (HFpEF) were under-represented; and (2) most trials were undertaken in a hospital or centre-based setting. OBJECTIVES To assess the effects of ExCR on mortality, hospital admission, and health-related quality of life of adults with heart failure. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and Web of Science without language restriction on 13 December 2021. We also checked the bibliographies of included studies, identified relevant systematic reviews, and two clinical trials registers. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared ExCR interventions (either exercise only or exercise as part of a comprehensive cardiac rehabilitation) with a follow-up of six months or longer versus a no-exercise control (e.g. usual medical care). The study population comprised adults (≥ 18 years) with heart failure - either HFrEF or HFpEF. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were all-cause mortality, mortality due to heart failure, all-cause hospital admissions, heart failure-related hospital admissions, and HRQoL. Secondary outcomes were costs and cost-effectiveness. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 60 trials (8728 participants) with a median of six months' follow-up. For this latest update, we identified 16 new trials (2945 new participants), in addition to the previously identified 44 trials (5783 existing participants). Although the existing evidence base predominantly includes patients with HFrEF, with New York Heart Association (NYHA) classes II and III receiving centre-based ExCR programmes, a growing body of trials includes patients with HFpEF with ExCR undertaken in a home-based setting. All included trials employed a usual care comparator with a formal no-exercise intervention as well as a wide range of active comparators, such as education, psychological intervention, or medical management. The overall risk of bias in the included trials was low or unclear, and we mostly downgraded the certainty of evidence of outcomes upon GRADE assessment. There was no evidence of a difference in the short term (up to 12 months' follow-up) in the pooled risk of all-cause mortality when comparing ExCR versus usual care (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.71 to 1.21; absolute effects 5.0% versus 5.8%; 34 trials, 36 comparisons, 3941 participants; low-certainty evidence). Only a few trials reported information on whether participants died due to heart failure. Participation in ExCR versus usual care likely reduced the risk of all-cause hospital admissions (RR 0.69, 95% CI 0.56 to 0.86; absolute effects 15.9% versus 23.8%; 23 trials, 24 comparisons, 2283 participants; moderate-certainty evidence) and heart failure-related hospital admissions (RR 0.82, 95% CI 0.49 to 1.35; absolute effects 5.6% versus 6.4%; 10 trials; 10 comparisons, 911 participants; moderate-certainty evidence) in the short term. Participation in ExCR likely improved short-term HRQoL as measured by the Minnesota Living with Heart Failure (MLWHF) questionnaire (lower scores indicate better HRQoL and a difference of 5 points or more indicates clinical importance; mean difference (MD) -7.39 points, 95% CI -10.30 to -4.77; 21 trials, 22 comparisons, 2699 participants; moderate-certainty evidence). When pooling HRQoL data measured by any questionnaire/scale, we found that ExCR may improve HRQoL in the short term, but the evidence is very uncertain (33 trials, 37 comparisons, 4769 participants; standardised mean difference (SMD) -0.52, 95% CI -0.70 to -0.34; very-low certainty evidence). ExCR effects appeared to be consistent across different models of ExCR delivery: centre- versus home-based, exercise dose, exercise only versus comprehensive programmes, and aerobic training alone versus aerobic plus resistance programmes. AUTHORS' CONCLUSIONS This updated Cochrane review provides additional randomised evidence (16 trials) to support the conclusions of the previous 2018 version of the review. Compared to no exercise control, whilst there was no evidence of a difference in all-cause mortality in people with heart failure, ExCR participation likely reduces the risk of all-cause hospital admissions and heart failure-related hospital admissions, and may result in important improvements in HRQoL. Importantly, this updated review provides additional evidence supporting the use of alternative modes of ExCR delivery, including home-based and digitally-supported programmes. Future ExCR trials need to focus on the recruitment of traditionally less represented heart failure patient groups including older patients, women, and those with HFpEF.
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Affiliation(s)
- Cal Molloy
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Linda Long
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ify R Mordi
- Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Charlene Bridges
- Institute of Health Informatics Research, University College London, London, UK
| | | | - Edward J Davies
- Department of Cardiology, Royal Devon & Exeter Healthcare Foundation Trust, Exeter, UK
| | | | - Hasnain Dalal
- Department of Primary Care, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospitals Trust, Truro, UK
- Primary Care Research Group, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Karen Rees
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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Cotie LM, Vanzella LM, Pakosh M, Ghisi GLDM. A Systematic Review of Clinical Practice Guidelines and Consensus Statements for Cardiac Rehabilitation Delivery: Consensus, Divergence, and Important Knowledge Gaps. Can J Cardiol 2024; 40:330-346. [PMID: 38376955 DOI: 10.1016/j.cjca.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND After 2020, clinical practice recommendations have been released to inform cardiac rehabilitation (CR) programs of best practices for post-COVID programming. The objective of this systematic review was to identify and summarize recommendations from clinical practice guidelines (CPGs) and consensus statements for CR delivery postpandemic. METHODS Five databases (March 2020 through April 2023), grey literature and Web sites of CR international associations were searched. Inclusion criteria were local, national, and international association-endorsed CPGs, and/or position, expert, and scientific statements related to CR delivery (program models, program elements, and core components). Two researchers independently screened the citations for inclusion. The Appraisal of Guidelines for Research and Evaluation (AGREE) II was used for quality assessment. Results were analyzed in accordance with the Synthesis Without Meta-analysis (SWiM) reporting guidelines. RESULTS Overall, 4890 records were identified; 4 CPGs, 9 position/scientific statements, and 6 expert/Delphi consensus papers were included. All guidelines/statements included information related to program delivery models, with 95% endorsing the use of virtual, hybrid, home-based, and telerehabilitation, especially during the pandemic. Outside of the context of COVID-19, program components including referral, CR indications, CR contraindications, timing, and structure were included in the 4 CPGs and 2 of 15 statements. Recommendations related to CR core components were primarily focused on exercise, with no changes since before the pandemic except for COVID-19 considerations for safety. One guideline was specific to women, and 1 scientific statement to heart failure with preserved ejection fraction. CONCLUSIONS Although 19 documents were identified, CR delivery in low resource settings and for culturally and linguistically diverse populations require attention. Additionally, few recommendations on nutrition, psychosocial counselling, and patient education were reported.
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Affiliation(s)
- Lisa M Cotie
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto, Ontario, Canada
| | - Lais M Vanzella
- University Health Network Cardiovascular Prevention and Rehabilitation Program, Toronto, Ontario, Canada
| | - Maureen Pakosh
- Library and Information Services, University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Gabriela Lima de Melo Ghisi
- KITE Research Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
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21
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Ilgaz A, Dagistan Akgöz A, Gözüm S. Impaired perception of cardiovascular risk and health literacy in individuals with high cardiovascular diseases risk from different socioeconomic levels in Antalya, Turkey. Aust J Prim Health 2024; 30:PY23178. [PMID: 38467076 DOI: 10.1071/py23178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND This study aimed to determine how the frequency of impaired perception of cardiovascular disease (CVD) risk is correlated with health literacy in individuals with high CVD risk in two regions with different socioeconomic levels. METHODS A descriptive study was conducted. The Systematic Coronary Risk Estimation, recommended by the European and Turkish Cardiology Societies, provides recommendations based on individuals' actual CVD risk levels. According to the Systematic Coronary Risk Estimation, participants suffering from diseases were identified as high and very high risk. The perception of risk was determined by subjectively assessing the risk level of the individuals. The European Health Literacy Survey Questionnaire was used. The Mann-Whitney U test, Chi-squared test and Spearman's correlation analysis were used to analyse the data. We also conducted a logistic regression analysis to identify factors contributing to impaired perception of CVD risk. RESULTS A total of 384 individuals, aged between 40 and 70years (with a mean age of 58.35±8.33years), were included in the study. These individuals had a high risk of CVD and were registered to family health centres from two different socioeconomic levels. Out of the 384 participants, 201 individuals belonged to the lower socioeconomic level region and 183 individuals belonged to the higher socioeconomic level region. A total of 61.7% of the participants with high CVD risk had an impaired perception of CVD risk. The health literacy level of 59.9% of individuals was either inadequate or problematic. The health literacy score of participants with impaired risk perception (29.59±9.07) was lower than those with correct risk perception (35.83±10.94; P <0.001). Factors that affected the perception of CVD risk included age, education level, working status, occupation, a family history of CVD, the CVD risk assessment by health professionals and the recommendation of health professionals to individuals for CVD screening. CONCLUSIONS It is necessary for health care professionals to make risk assessments and perform interventions to improve health literacy to raise the awareness of individuals with high CVD risk on their actual risk.
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Affiliation(s)
- Aysegül Ilgaz
- Akdeniz University, Faculty of Nursing, Dumlupinar Boulevard, Antalya 07058, Turkey
| | - Ayse Dagistan Akgöz
- Akdeniz University, Faculty of Nursing, Dumlupinar Boulevard, Antalya 07058, Turkey
| | - Sebahat Gözüm
- Akdeniz University, Faculty of Nursing, Dumlupinar Boulevard, Antalya 07058, Turkey
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22
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Inayat S, Hayden KA, Campbell T, Shier KK. Barriers and Facilitators of Center-Based Cardiac Rehabilitation Utilization in South Asian Ethnic Minorities: A META-SYNTHESIS. J Cardiopulm Rehabil Prev 2024; 44:91-98. [PMID: 37947519 DOI: 10.1097/hcr.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
AIM The aim of this review was to synthesize literature on the perceptions of South Asian ethnic minorities of the barriers and facilitators to center-based, phase II cardiac rehabilitation (CR). METHODS A meta-synthesis approach was used, and findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted from database inception dates to July 2022 using the following databases: MEDLINE, EMBASE, APA PsycINFO, Cochrane Database of Systematic Review, CINAHL, Scopus, and Web of Science. The inclusion criteria were studies that examined the barriers and/or facilitators of structured center-based CR among South Asian adult ethnic minorities. Critical appraisal of the included studies was conducted using the Mixed Methods Appraisal Tool. Findings were synthesized using a thematic synthesis approach. RESULTS Among the 7110 records initially retrieved only nine studies conducted in the United Kingdom or Canada met the inclusion criteria. More barriers than facilitators were studied and reported. Key barriers were the English language difficulty, fatalistic beliefs, previous bad interactions with and negative perception of health care professionals, transportation problems, work schedule conflict, safety issues, and long-distance CR centers. The facilitators included patient-preferred environment, presence of family members during exercise, family and friends support, and encouragement to change lifestyle and enroll in a CR program. CONCLUSION The review findings revealed that South Asian ethnic minorities encounter various barriers and facilitators to enroll and complete CR. The findings can inform researchers and clinicians in the development of interventions that are tailored to their cultural needs. PRACTICE IMPLICATIONS The findings can be valuable to health care professionals and policy makers in designing customized CR programs for South Asian minorities.
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Affiliation(s)
- Shahzad Inayat
- Faculty of Nursing (Mr Inayat and Dr Shier), Libraries and Cultural Resources (Dr Hayden), and Department of Psychology (Dr Campbell), University of Calgary, Calgary, Alberta, Canada
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23
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Economidou EC, Lianopoulou B, Soteriades S, Soteriades ES. Cardiac Rehabilitation Programs: Content, Effectiveness, Limitations, and Gaps in Knowledge. Cardiol Rev 2024; 32:157-161. [PMID: 36730494 DOI: 10.1097/crd.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cardiac rehabilitation (CR) constitutes a valuable therapeutic approach for patients with a broad spectrum of cardiovascular diseases facilitating the development and maintenance of a desirable level of physical, social, and psychological functioning following the onset of cardiovascular disease. Nowadays, cardiac rehabilitation programs emphasize the use of a multidisciplinary approach. The current review aims at presenting the state-of-the-art knowledge on the indications of patients entering cardiac rehabilitation programs, including their core components, duration, and effectiveness. Following a careful review of the international literature, we conclude that there are significant differences between the most commonly cited international CR guidelines as well as additional limitations and gaps in knowledge. Despite the benefits associated with CR and despite their widespread acceptance, CR referrals and program attendance remains low, while many questions have not been so far addressed through scientific research. Overall, the findings of our study suggest a critical need for the development of robust and evidence-based standardized CR interventions to increase their use and effectiveness throughout the world.
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Affiliation(s)
- Eleftheria C Economidou
- From the Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Barbara Lianopoulou
- Management Organization Unit of Development Programs, Human Resource Management, Ministry of Development and Investments, Republic of Greece, Athens, Greece
| | - Soteris Soteriades
- Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
| | - Elpidoforos S Soteriades
- Healthcare Management Program, School of Economics and Management, Open University of Cyprus, Nicosia, Cyprus
- Environmental and Occupational Medicine and Epidemiology (EOME), Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
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24
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Schmidt AM, Bloch‐Nielsen JR, Nørgaard H, Hannibal L, Jensen SHJ, Tang LH, Rolving N. A novel referral strategy to enhance the enrollment of patients with heart failure in cardiac rehabilitation: A feasibility study. Health Sci Rep 2024; 7:e1961. [PMID: 38469113 PMCID: PMC10925803 DOI: 10.1002/hsr2.1961] [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: 11/02/2023] [Revised: 01/25/2024] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
Background and Aims Rehabilitation targeting patients with cardiac conditions are evident and acknowledged in clinical guidelines. However, participation rates remain suboptimal, with only 50% of all patients with cardiac conditions participating in these programs across Europe. Considering the well-documented effects of rehabilitation, increasing the referral rate to cardiac rehabilitation would be desirable. This study aimed to evaluate the feasibility of a novel referral strategy that could potentially enhance enrollment in cardiac rehabilitation for patients with heart failure. Methods This prospective feasibility study incorporating both quantitative and qualitative methods was conducted in an outpatient heart failure clinic and a municipal health care center. 106 patients with heart failure were referred to the heart failure clinic from September 2021 through July 2022. A 15-20 min face-to-face physiotherapy consultation was incorporated into usual care, evaluating patients' habitual and actual level of functioning, disability, and physical activity and assessing their potential need and motivation for cardiac rehabilitation. Three predefined quantitative feasibility outcomes: reach, referral rate, and data completeness were assessed. Additionally, semi-structured interviews explored acceptability among patients and health care professionals at the municipal health care center and the hospital. Finally, the potential effect was assessed based on the enrollment rate. Results Physiotherapy consultations were offered to 86% of eligible patients; of these, 52% were referred to cardiac rehabilitation. Ninety-one percent data completeness was achieved. The intervention was well-accepted by patients and health care professionals. The enrollment rate reached 79%. Conclusion The novel referral strategy proved feasible concerning reach and data completeness, although the referral rate suggested that further refinements are required before a full-scale trial. The novel referral strategy was well-accepted, and enrollment rate approached an acceptable level.
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Affiliation(s)
- Anne Mette Schmidt
- Medical Diagnostic CenterUniversity Research Clinic for Innovative Patient PathwaysSilkeborgDenmark
| | | | - Helene Nørgaard
- Department of Physio‐ and Occupational Therapy, Diagnostic CenterSilkeborg Regional HospitalDenmark
| | - Loui Hannibal
- Department of Physio‐ and Occupational Therapy, Diagnostic CenterSilkeborg Regional HospitalDenmark
| | - Sarah Holm Junge Jensen
- Medical Diagnostic CenterUniversity Research Clinic for Innovative Patient PathwaysSilkeborgDenmark
| | - Lars Hermann Tang
- Department of Physiotherapy and Occupational Therapy, Næstved‐Ringsted‐Slagelse HospitalThe Research Unit PROgrezSlagelseDenmark
- The Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Nanna Rolving
- Department of Physiotherapy and Occupational TherapyAarhus University HospitalAarhus NDenmark
- Department of Public HealthAarhus UniversityAarhus CDenmark
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25
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Dibben GO, Hannay JR, Taylor RS. Exercise training in heart failure. Heart 2024; 110:373-381. [PMID: 37460196 DOI: 10.1136/heartjnl-2022-321132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Affiliation(s)
| | - Jennifer R Hannay
- Wirral Community Cardiology Service, Wirral Community Health and Care NHS Foundation Trust, Birkenhead, UK
| | - Rod S Taylor
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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26
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Shawon MSR, Hsu B, Chard R, Nicholson IA, Elias VL, Nicola LK, Moore CR, Hirschhorn AD, Jorm LR, Mungovan SF. Six-minute walk test distance at time of hospital discharge is strongly and independently associated with all-cause mortality following cardiac surgery. Sci Rep 2024; 14:2493. [PMID: 38291336 PMCID: PMC10827724 DOI: 10.1038/s41598-024-52601-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/21/2024] [Indexed: 02/01/2024] Open
Abstract
We investigated the impact of distance covered in the six-minute walk test (6mWT) before being discharged from the hospital after cardiac surgery on the risk of all-cause mortality. Our study included 1127 patients who underwent cardiac surgery and then took part in a standardised physiotherapist-supervised inpatient rehabilitation programme during 2007-2017. The percentage of the predicted 6mWT distance, and the lower limit of normal distance was calculated based on individual patients' age, sex, and body mass index. We used Cox regression with adjustment for confounders to determine multivariable-adjusted hazard ratios (HRs) for mortality. Over a median follow-up period of 6.4 (IQR: 3.5-9.2) years, 15% (n = 169) patients died. We observed a strong and independent inverse association between 6mWT distance and mortality, with every 10 m increase in distance associated to a 4% reduction in mortality (HR: 0.96, 95% CI 0.94-0.98, P < 0.001). Those in the top tertile for predicted 6mWT performance had a 49% reduced risk of mortality (HR: 0.51, 95% CI 0.33-0.79) compared to those in the bottom tertile. Patients who met or exceeded the minimum normal 6mWT distance had 36% lower mortality risk (HR: 0.64, 95% CI 0.45-0.92) compared to those who did not meet this benchmark. Subgroup analysis showed that combined CABG and valve surgery patients walked less in the 6mWT compared to those undergoing isolated CABG or valve surgeries, with a significant association between 6mWT and mortality observed in the isolated procedure groups only. In conclusion, the longer the distance covered in the 6mWT before leaving the hospital, the lower the risk of mortality.
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Affiliation(s)
| | - Benjumin Hsu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Richard Chard
- Department of Cardiothoracic Surgery, Westmead Private Hospital, Westmead, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Ian A Nicholson
- Department of Cardiothoracic Surgery, Westmead Private Hospital, Westmead, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Victoria L Elias
- Westmead Private Hospital Physiotherapy Services, Westmead Private Hospital Sydney, Westmead, NSW, Australia
| | - Lauren K Nicola
- Westmead Private Hospital Physiotherapy Services, Westmead Private Hospital Sydney, Westmead, NSW, Australia
| | - Corrina R Moore
- Westmead Private Hospital Physiotherapy Services, Westmead Private Hospital Sydney, Westmead, NSW, Australia
| | - Andrew D Hirschhorn
- MQ Health, Faculty of Medicine, Health and Human Sciences, Macquarie University, Maquarie Park, NSW, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Sean F Mungovan
- Westmead Private Hospital Physiotherapy Services, Westmead Private Hospital Sydney, Westmead, NSW, Australia.
- The Clinical Research Institute, Westmead, NSW, Australia.
- Department of Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia.
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27
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Shi W, Green H, Sikhosana N, Fernandez R. Effectiveness of Telehealth Cardiac Rehabilitation Programs on Health Outcomes of Patients With Coronary Heart Diseases: An Umbrella Review. J Cardiopulm Rehabil Prev 2024; 44:15-25. [PMID: 37335820 DOI: 10.1097/hcr.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
PURPOSE The aim of this study was to conduct an umbrella review summarizing the evidence from existing systematic reviews of telehealth cardiac rehabilitation (CR) on health outcomes of patients with coronary heart disease (CHD). REVIEW METHODS An umbrella review of systematic reviews was undertaken in accordance with the PRISMA and JBI guidelines. A systematic search was conducted in Medline, APA PsycINFO, Embase, CINAHL, Web of Science, Cochrane database of systematic reviews, JBI evidence synthesis, Epistemonikos, and PROSPERO, searching for systematic reviews published from 1990 to current and was limited to the language source of English and Chinese. Outcomes of interest were health behaviors and modifiable CHD risk factors, psychosocial outcomes, and other secondary outcomes. Study quality was appraised using the JBI checklist for systematic reviews. A narrative analysis was conducted, and meta-analysis results were synthesized. SUMMARY From 1301 identified reviews, 13 systematic reviews (10 meta-analyses) comprised 132 primary studies conducted in 28 countries. All the included reviews have high quality, with scores ranging 73-100%. Findings to the health outcomes remained inconclusive, except solid evidence was found in the significant improvement in physical activity (PA) levels and behaviors from telehealth interventions, exercise capacity from mobile health (m-health) only and web-based only interventions, and medication adherence from m-health interventions. Telehealth CR programs, work adjunct or in addition to traditional CR and standard care, are effective in improving health behaviors and modifiable CHD risk factors, particularly in PA. In addition, it does not increase the incidence in terms of mortality, adverse events, hospital readmission, and revascularization.
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Affiliation(s)
- Wendan Shi
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, New South Wales, Australia (Ms Shi, Dr Green, Mr Sikhosana, and Dr Fernandez); Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia (Ms Shi); Faculty of Medicine and Health, University of Newcastle, Callaghan, New South Wales, Australia (Mr Sikhosana and Dr Fernandez); and School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, and Centre for Evidence based Initiatives in Health Care: A JBI Centre for Excellence, Wollongong, New South Wales, Australia (Dr Green)
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Wang Y, Chen Y, Zhang X, Liu S. Attitude of cardiac surgery nurses on kinesiophobia management: a qualitative study. BMJ Open 2023; 13:e074438. [PMID: 38159957 PMCID: PMC10759056 DOI: 10.1136/bmjopen-2023-074438] [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: 04/06/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES This study aimed to investigate the knowledge, attitudes and practical experiences of cardiac surgery nurses regarding kinesiophobia management during early mobilisation. DESIGN Using a descriptive qualitative research method, 21 cardiac surgery nurses participated in this study from October 2022 to January 2023, and the interview data were analysed using the Colaizzi 7-step analysis method. SETTING Data were collected through in-depth face-to-face or online interviews in a tertiary hospital located in Nanjing, China. PARTICIPANTS 21 cardiac surgery nurses were interviewed from October 2022 to January 2023. RESULTS Two themes were summarised: knowledge, attitude and practice of nurses (high recognition and low participation; low knowledge reserve; low willingness); the promotion and essential elements of kinesiophobia management (efficient health education model; stable medical staff-family caregiver collaboration; simplified clinical protocol; specialist nursing team; clarify the multidisciplinary division of labour). CONCLUSION The management of kinesiophobia in patients undergoing cardiac surgery is currently in the developmental phase. It is advisable to give due consideration to emotional support and cognitive training for medical staff. In addition, a workable management plan, consistent with clinical practice, should be formulated through multidisciplinary and medical staff-family caregiver collaboration to optimise patient outcomes.
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Affiliation(s)
- YuChen Wang
- The Third School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - YuHong Chen
- Department of Nursing, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - XiaoMin Zhang
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - SiYu Liu
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Felix CMDM, Pereira DAG, Pakosh M, da Silva LP, Ghisi GLDM. A Scoping Review of Measurement Tools Evaluating Awareness and Disease-Related Knowledge in Peripheral Arterial Disease Patients. J Clin Med 2023; 13:107. [PMID: 38202114 PMCID: PMC10780123 DOI: 10.3390/jcm13010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic cardiovascular morbidity worldwide, with high prevalence and associated complications, and is often overlooked and undertreated. Research has shown that there is a profound lack of PAD-related knowledge and awareness; additionally, information sources are not often reliable and accessible. The objective of this scoping review was: (1) to identify and critically appraise instruments that measure patients' disease-related knowledge/awareness about PAD, and (2) to characterize the current state of knowledge/awareness levels among these patients. METHODS This systematic review was conducted and reported in accordance with the PRISMA statement. Six databases (APA PsycInfo, CINAHL Ultimate, Embase, Emcare Nursing, Medline ALL and Web of Science Core Collection) were searched, and search strategies were developed utilizing the PICO framework. Potential studies of any methodological design were considered for inclusion through a snowball hand search. Data from the included articles were extracted by a reviewer, and the extraction accuracy was independently cross-checked by another author. RESULTS The initial database search yielded 9832 records, of which sixteen studies (thirteen quantitative and three qualitative) were included. Only three questionnaires had their psychometric properties assessed. Questionnaire items focused on the following topics: definition/characteristics, risk factors/causes, treatment, complications, and personal issues regarding the perception/management of the disease. Overall, knowledge/awareness about PAD was low among patients. CONCLUSIONS This study identified major gaps in PAD education, including the lack of availability of a validated measurement tool addressing all educational topics relevant to care and low knowledge/awareness of patients about their condition.
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Affiliation(s)
- Carolina Machado de Melo Felix
- Graduate Program in Rehabilitation Sciences, Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (C.M.d.M.F.); (D.A.G.P.)
| | - Danielle Aparecida Gomes Pereira
- Graduate Program in Rehabilitation Sciences, Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (C.M.d.M.F.); (D.A.G.P.)
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada;
| | - Lilian Pinto da Silva
- Graduate Program in Rehabilitation Sciences and Physical Functional Performance, Faculty of Physiotherapy, Universidade Federal de Juiz de Fora, Juiz de Fora 36036-900, Brazil;
| | - Gabriela Lima de Melo Ghisi
- Library & Information Services, Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada;
- KITE Research Institute, University Health Network, Toronto, ON M4G 1R7, Canada
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Helmark C, Harrison A, Pedersen SS, Doherty P. Screening for - and prevalence of - anxiety and depression in cardiac rehabilitation in the post-COVID era. An observational study. Int J Cardiol 2023; 393:131379. [PMID: 37734491 DOI: 10.1016/j.ijcard.2023.131379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Approximately 20-30% of patients with a cardiac disease suffer from anxiety and/or depression, leading to poor health outcomes. To identify this subgroup, clinical guidelines recommend screening for anxiety and depression in cardiac rehabilitation (CR). It is unknown how screening practice is delivered post-COVID. METHODS This observational study used data from the National Audit of Cardiac Rehabilitation from April 2018-March 2022. Descriptive statistics were used to assess screening rates and prevalence, while a multivariate logistic regression model was performed to analyse determinants for screening for anxiety and depression among patients participating in cardiac rehabilitation. RESULTS The population consisted of 245,705 patients, where 128,643 (52.4%) were screened and 117,062 (47.6%) were not. Patients attending CR during first year of COVID-19 were less likely to be screened. Patients with female gender, living alone, non-white ethnicity, living in the most deprived areas, current smoking, and physical inactivity were less likely to be screened, while patients who were revascularized, having an objective physical fitness test, and attending a certified CR center were more likely to be screened. For patients attending CR during COVID-19, the prevalence of anxiety and depression decreased significantly. For anxiety the prevalence dropped from 34.4% to 15.8%, for depression the prevalence dropped from 33.5% to 16.5%. CONCLUSION CR service provision was negatively impacted during COVID-19, leading to much lower screening for anxiety and depression in the CR setting. Prevalence of anxiety and depression decreased during COVID-19 for this population, possibly because psychologically affected patients refrained from attending CR.
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Affiliation(s)
- Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark; Department of Psychology, University of Southern Denmark, Campusvej 55, 5330 Odense M, Denmark.
| | - Alex Harrison
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5330 Odense M, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsloews Vej 4, 5000 Odense, Denmark
| | - Patrick Doherty
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom
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Darvishzadehdaledari S, Harrison A, Gholami F, Azadnia A. Examining the effectiveness of home-based cardiac rehabilitation programs for heart failure patients with reduced ejection fraction: a critical review. BMC Cardiovasc Disord 2023; 23:593. [PMID: 38053086 PMCID: PMC10696730 DOI: 10.1186/s12872-023-03640-x] [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: 07/30/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Heart failure (HF) is the most common cardiovascular reason for hospital admission, particularly among patients older than 60 years old. Heart failure with reduced ejection fraction (HFrEF) comprises approximately 50% of all heart failure cases. Home-based cardiac rehabilitation (HBCR) is an alternative option to enhance the participation rate in cardiac rehabilitation (CR) interventions for patients who are not able to attend center-based cardiac rehabilitation (CBCR). The purpose of this review is to clarify the extent to which present studies of HBCR align with the core components defined by both the European Society of Cardiology (ESC) and the British Association for Cardiac Prevention and Rehabilitation (BACPR). METHODS A critical review was conducted through four databases, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews, to identify randomized controlled trials up until June 2022. We scrutinized the commonalities between BACPR and ESC and developed a list of standards. The risk of bias was assessed using the RoB 2 tool. RESULTS Among the 87 papers selected for full-text screening, 11 studies met the inclusion criteria. Six papers possessed a high proportion of fidelity to essential standards, four studies had a medium alliance, and one intervention had a low level of alliance. CONCLUSION Overall, the majority of included studies had medium to high alignment with standards and core components. However, a need for more attention to long-term strategy as an important standard is revealed. Rapid identification and initial assessment are the most met standards; however, lifestyle risk factor management and long-term outcomes were recognized as the least met standards.
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Affiliation(s)
| | | | - Fatemeh Gholami
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Arian Azadnia
- Research and Technology Deputy, Maragheh University of Medical Sciences, Maragheh, Iran.
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Song IS, Park YS, Jang SY, Nam JM, Lee CJ, Park EC. Impact of cardiac rehabilitation on cardiovascular event in Korea. Sci Rep 2023; 13:19146. [PMID: 37932406 PMCID: PMC10628201 DOI: 10.1038/s41598-023-46503-3] [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: 05/07/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023] Open
Abstract
This study aimed to evaluate the effects of cardiac rehabilitation (CR) on major adverse cardiac events (MACE) among patients who underwent PCI procedure. We used data from the electronic medical records (EMR) of a tertiary hospital in Seoul, Korea, from January 2014 to February 2020. Data from 2988 patients who had experienced their first acute coronary syndrome (ACS) and had undergone percutaneous coronary intervention (PCI) were included during the study period. we classified patients into CR participants and non-participants based on their participation in the cardiac rehabilitation (CR) program within 30 days after discharge. And the outcome was the incidence of myocardial infarction (MI) and stroke within 1 year after discharge. The association between participation in CR and risk of developing MACE was evaluated using the Cox proportional hazards model. Patients who achieved CR after undergoing PCI were at a lower risk of developing MI (HR 0.68, CI 0.53-0.86). There was no significant association between participation in CR and the incidence of stroke. Among patients who had more than three stenotic vessels, the risk of developing MI within 1 year of discharge was reduced in CR users compared to non-users (3 or more stenosis vessels: HR 0.55, CI 0.35-0.86). Among patients who used two and more stents during PCI procedures, the risk of developing MI within 1 year of discharge was reduced in CR users compared to non-users (2 and more stents: HR 0.54, CI 0.35-0.85). Among people diagnosed with ACS and receiving PCI, patients who participated in CR within one month of discharge reduced risk of developing MI. Our study reinforced the current evidence on the effect of CR among patients receiving PCI and presented the expansion and enhancement of the CR program.
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Affiliation(s)
- In Sun Song
- Department of Health Policy, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Yu Shin Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Jung Mo Nam
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-to, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-to, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Xu W, Yu EYT, Chin WY, Mak IL, Chan CIY, Lam CLK, Wan EYF. Team-based continuity of care for patients with hypertension: a retrospective primary care cohort study in Hong Kong. Br J Gen Pract 2023; 73:e807-e815. [PMID: 37845086 PMCID: PMC10587903 DOI: 10.3399/bjgp.2023.0150] [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: 03/24/2023] [Accepted: 07/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Continuity of care (COC) is associated with improved health outcomes in patients with hypertension. Team-based COC allows more flexibility in service delivery but there is a lack of research on its effectiveness for patients with hypertension. AIM To investigate the effectiveness of team-based COC on the prevention of cardiovascular disease (CVD) and mortality in patients with hypertension. DESIGN AND SETTING A retrospective cohort study in a primary care setting in Hong Kong. METHOD Eligible patients included those visiting public primary care clinics in Hong Kong from 2008 to 2018. The usual provider continuity index (UPCI) was used to measure the COC provided by the most visited physician team. Cox regression and restricted cubic splines were applied to model the association between the COC and the risk for CVDs and all-cause mortality. RESULTS This study included 421 640 eligible patients. Compared with participants in the lowest quartile of UPCI, the hazard ratios for overall CVD were 0.94 (95% CI = 0.92 to 0.96), 0.91(95% CI = 0.89 to 0.93), and 0.90 (95% CI = 0.88 to 0.92) in the second, third, and fourth quartiles, respectively. A greater effect size on CVD risk reduction was observed among the patients with unsatisfactory blood pressure control, patients aged <65 years, and those with a Charlson comorbidity index of <4 at baseline (Pinteraction<0.05 in these subgroup analyses), but the effect was insignificant among the participants with an estimated glomerular filtration rate of <60 ml/ min/1.73 m2 at baseline. CONCLUSION Team-based COC via a coordinated physician team was associated with reduced risks of CVD and all-cause mortality among patients with hypertension, especially for the patients with unsatisfactory blood pressure control. Early initiation of team-based COC may also achieve extra benefits.
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Affiliation(s)
- Wanchun Xu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region (SAR)
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region (SAR)
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region (SAR)
| | - Ivy Lynn Mak
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region (SAR)
| | - Cheyenne I Ying Chan
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region (SAR)
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR; Department of Family Medicine, University of Hong Kong, Shenzhen Hospital, Shenzhen
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, and Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR
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Hwang R, Gane EM, Morris NR. No transport? No worries! Cardiac telerehabilitation is a feasible and effective alternative to centre-based programs. Heart Fail Rev 2023; 28:1277-1284. [PMID: 36802044 PMCID: PMC9938679 DOI: 10.1007/s10741-023-10301-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/21/2023]
Abstract
Given the under-utilisation of cardiac rehabilitation despite its benefits, there has been a shift towards alternative delivery models. The recent coronavirus disease 2019 (COVID-19) pandemic has accelerated this shift, leading to a growing interest in home-based cardiac rehabilitation including telerehabilitation. There is increasing evidence to support cardiac telerehabilitation, with studies generally demonstrating comparable outcomes and potential cost-benefits. This review aims to provide a synopsis of the current evidence on home-based cardiac rehabilitation with a focus on telerehabilitation and practical considerations.
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Affiliation(s)
- Rita Hwang
- Department of Physiotherapy, Princess Alexandra Hospital, Metro South Health, Ipswich Road, Woolloongabba, QLD 4102, Brisbane, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
- School of Allied Health Sciences and Menzies Health Institute, Griffith University, Gold Coast, Australia.
| | - Elise M Gane
- Department of Physiotherapy, Princess Alexandra Hospital, Metro South Health, Ipswich Road, Woolloongabba, QLD 4102, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Norman R Morris
- School of Allied Health Sciences and Menzies Health Institute, Griffith University, Gold Coast, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Metro North Health, Brisbane, Australia
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McCann WD, Hou XY, Stolic S, Ireland MJ. Predictors of Psychological Distress among Post-Operative Cardiac Patients: A Narrative Review. Healthcare (Basel) 2023; 11:2721. [PMID: 37893795 PMCID: PMC10606887 DOI: 10.3390/healthcare11202721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Following surgery, over 50% of cardiac surgery patients report anxiety, stress and/or depression, with at least 10% meeting clinical diagnoses, which can persist for more than a year. Psychological distress predicts post-surgery health outcomes for cardiac patients. Therefore, post-operative distress represents a critical recovery challenge affecting both physical and psychological health. Despite some research identifying key personal, social, and health service correlates of patient distress, a review or synthesis of this evidence remains unavailable. Understanding these factors can facilitate the identification of high-risk patients, develop tailored support resources and interventions to support optimum recovery. This narrative review synthesises evidence from 39 studies that investigate personal, social, and health service predictors of post-surgery psychological distress among cardiac patients. The following factors predicted lower post-operative distress: participation in pre-operative education, cardiac rehabilitation, having a partner, happier marriages, increased physical activity, and greater social interaction. Conversely, increased pain and functional impairment predicted greater distress. The role of age, and sex in predicting distress is inconclusive. Understanding several factors is limited by the inability to carry out experimental manipulations for ethical reasons (e.g., pain). Future research would profit from addressing key methodological limitations and exploring the role of self-efficacy, pre-operative distress, and pre-operative physical activity. It is recommended that cardiac patients be educated pre-surgery and attend cardiac rehabilitation to decrease distress.
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Affiliation(s)
- William D. McCann
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD 4305, Australia;
| | - Xiang-Yu Hou
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Snezana Stolic
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, QLD 4305, Australia;
| | - Michael J. Ireland
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD 4305, Australia;
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Kinsara AJ, Aljehani R, Wolszakiewicz J, Staron A, Alsulaimy MA. The Prevention and Cardiac Rehabilitation Group of the Saudi Heart Association Recommendations Regarding Establishing a Cardiac Rehabilitation Service. J Saudi Heart Assoc 2023; 35:205-213. [PMID: 37700757 PMCID: PMC10495045 DOI: 10.37616/2212-5043.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Cardiac rehabilitation (CR) is a cornerstone in the secondary prevention of cardiovascular disease (CVD). Comprehensive cardiac rehabilitation has obtained the highest class of recommendation and the level of evidence for the treatment of patients with ST-segment elevation myocardial infarction, after myocardial revascularization, with chronic coronary syndromes, and in patients with heart failure (HF). Comprehensive cardiac rehabilitation should be implemented as soon as possible, be multi-phasic, and adjusted to the individual needs of the patient. CR is still suboptimally used, and many cardiac centers do not have such services (2). The provision of CR services should be based on standards and key performance indicators, and guidelines containing a minimum standard of cardiac rehabilitation utilization should be published to improve the quality of the CR program. This document presents an expert opinion that summarizes the current medical knowledge concerning the goals, target population, organization, clinical indications, and implementation methods of the CR program in the Kingdom of Saudi Arabia.
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Affiliation(s)
- Abdulhalim J. Kinsara
- Ministry of National Guard-Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, COM-WR, Jeddah,
Saudi Arabia
| | | | | | - Adam Staron
- Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
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Quach J, Kehler DS, Giacomantonio N, McArthur C, Blanchard C, Firth W, Rockwood K, Theou O. Association of admission frailty and frailty changes during cardiac rehabilitation with 5-year outcomes. Eur J Prev Cardiol 2023; 30:807-819. [PMID: 36799963 PMCID: PMC10335868 DOI: 10.1093/eurjpc/zwad048] [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] [Received: 11/24/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023]
Abstract
AIMS Examine the association between (1) admission frailty and (2) frailty changes during cardiac rehabilitation (CR) with 5-year outcomes (i.e. time to mortality, first hospitalization, first emergency department (ED) visit, and number of hospitalizations, hospital days, and ED visits). METHODS AND RESULTS Data from patients admitted to a 12-week CR programme in Halifax, Nova Scotia, from May 2005 to April 2015 (n = 3371) were analysed. A 25-item frailty index (FI) estimated frailty levels at CR admission and completion. FI improvements were determined by calculating the difference between admission and discharge FI. CR data were linked to administrative health data to examine 5-year outcomes [due to all causes and cardiovascular diseases (CVDs)]. Cox regression, Fine-Gray models, and negative binomial hurdle models were used to determine the association between FI and outcomes. On average, patients were 61.9 (SD: 10.7) years old and 74% were male. Mean admission FI scores were 0.34 (SD: 0.13), which improved by 0.07 (SD: 0.09) by CR completion. Admission FI was associated with time to mortality [HRs/IRRs per 0.01 FI increase: all causes = 1.02(95% CI 1.01,1.04); CVD = 1.03(1.02,1.05)], hospitalization [all causes = 1.02(1.01,1.02); CVD = 1.02(1.01,1.02)], ED visit [all causes = 1.01(1.00,1.01)], and the number of hospitalizations [all causes = 1.02(95% CI 1.01,1.03); CVD = 1.02(1.00,1.04)], hospital days [all causes = 1.01(1.01,1.03)], and ED visits [all causes = 1.02(1.02,1.03)]. FI improvements during CR had a protective effect regarding time to all-cause hospitalization [0.99(0.98,0.99)] but were not associated with other outcomes. CONCLUSION Frailty status at CR admission was related to long-term adverse outcomes. Frailty improvements during CR were associated with delayed all-cause hospitalization, in which a larger effect was associated with a greater chance of improved outcome.
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Affiliation(s)
- Jack Quach
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada
| | - Dustin Scott Kehler
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada
| | - Nicholas Giacomantonio
- Division of Cardiology, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7, Canada
- Department of Medicine, Dalhousie University, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
| | - Chris Blanchard
- Department of Medicine, Dalhousie University, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada
| | - Wanda Firth
- Queen Elizabeth II Health Sciences Centre, Heart Health, 1276 South Park St, Halifax, NS B3H 2Y9, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada
| | - Olga Theou
- School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, NS B3H 4R2, Canada
- Division of Geriatric Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Halifax, NS B3H 2E1, Canada
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Wells A, Heal C, Reeves D, Capobianco L. Prevalence of post-traumatic stress and tests of metacognition as a PTSD risk marker in patients with coronary heart disease and elevated HADS scores: analysis of data from the PATHWAY RCT's in UK cardiac rehabilitation. Front Psychiatry 2023; 14:1198202. [PMID: 37484675 PMCID: PMC10357285 DOI: 10.3389/fpsyt.2023.1198202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/30/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Anxiety and depression in coronary heart disease (CHD) are associated with poorer health outcomes, greater healthcare use and reduced quality of life. Post-traumatic stress symptoms may be a particular concern as they are associated with increased mortality at follow-up. We examined prevalence of PTSD in patients with elevated anxiety/depression scores referred for cardiac rehabilitation (CR) across seven NHS sites in North-West England. We tested a possible mechanism (metacognition) linking CHD to PTSD symptom severity as implicated in the metacognitive model. Methods Data was collected at baseline as part of the NIHR funded PATHWAY trial of metacognitive therapy for anxiety and depression in CHD. Patients (n = 572) with at least mild symptoms of anxiety and depression under routine screening (assessed with the Hospital Anxiety and Depression Scale) and attending CR were eligible for the study. A battery of questionnaires, including assessment of demographic variables, PTSD symptoms (using the IES-R) and metacognitive beliefs was administered prior to random allocation and intervention delivery. Results Rates of PTSD were high, with 48% of patients meeting threshold for PTSD and a further 15% partial PTSD. All five metacognition subscales were positively associated with PTSD vs. no PTSD, with beliefs about the uncontrollability and danger of worry and beliefs about need to control thoughts being most strongly related. For every unit increase in uncontrollability and danger metacognitions the odds of being in the PTSD group increased 30%, whilst the odds of partial PTSD increased 16%. Stepwise regression analysis using the metacognitive subscales along with demographic and health-related covariates found that uncontrollability/danger and need for control metacognitions explained unique variation in PTSD symptom severity, with unique contributions also for age, sex, and number of comorbidities. Conclusion PTSD symptoms appeared highly prevalent in the current CR sample. Metacognitive beliefs were individually associated with symptom severity with the strongest positive relationship observed for beliefs about uncontrollability and dangerousness of worry, followed by need to control thoughts. The results highlight the importance in assessing PTSD in CR patients and add support to implementing metacognitive therapy in CHD to target particular metacognition risk factors in anxiety, depression and PTSD.
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Affiliation(s)
- Adrian Wells
- Division of Psychology and Mental Health, School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Research and Innovation, Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
| | - Calvin Heal
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - David Reeves
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- NIHR School for Primary Care Research, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Lora Capobianco
- Research and Innovation, Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
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Tamura S, Miyata K, Igarashi T, Iizuka T, Otani T, Usuda S. Minimal clinically important difference of the short physical performance battery and comfortable walking speed in old-old adults with acute cardiovascular disease: a multicenter, prospective, observational study. Disabil Rehabil 2023; 45:1079-1086. [PMID: 35341435 DOI: 10.1080/09638288.2022.2052978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The physical function of older adults age ≥ 75 years hospitalized for cardiovascular disease (CVD) often decrease. The Minimal Clinically Important Difference (MCID) is the smallest clinically meaningful difference due to therapy. The Short Physical Performance Battery (SPPB) and Comfortable Walking Speed (CWS) are physical function evaluations commonly used in people with CVD. This study aims to clarify the MCIDs of the SPPB and CWS in old-old adult with CVD. MATERIALS AND METHODS This was a multicenter, prospective study of 58 old-old adults with acute CVD and rehabilitation. The MCID was estimated using the participants' and physical therapists' (PT) Global Rating of Change (GRC) scales as anchors for changes in the SPPB and CWS. The area under the curve (AUC) was used to measure the discrimination accuracy. RESULTS The MCID of SPPB was 3 points when the GRC from PT was used as an anchor (AUC = 0.70). The MCID of CWS was 0.10 m/s when the GRC from participants and PT were used as anchors (AUC = 0.70 and 0.73, respectively). CONCLUSIONS The MCID of 3 SPPB points and 0.10 m/s CWS in old-old adults with acute CVD may help determine the effectiveness of therapy and improve prognosis.Implications for rehabilitationFor people with cardiovascular disease (CVD), the Short Physical Performance Battery (SPPB) and comfortable walking speed (CWS) are often used to measure physical function.The MCID of SPPB and CWS was estimated to be 3 points and 0.10 m/s, respectively, in older adults with CVD aged ≥75 years.This finding is useful for clinicians to evaluate the efficacy of cardiac rehabilitation.
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Affiliation(s)
- Shuntaro Tamura
- Department of Rehabilitation, Fujioka General Hospital, Fujioka, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Tatsuya Igarashi
- Department of basic rehabilitation, Gunma University Graduate School of Health Sciences, Maebashi, Japan
- Numata Neurosurgery & Heart Disease Hospital, Numata, Japan
| | | | - Tomohiro Otani
- Department of Physical Therapy, Ota college of medical technology, Ota, Japan
| | - Shigeru Usuda
- Gunma University Graduate School of Health Sciences, Maebashi, Japan
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40
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Wang CL, Huan N, Wang PL, Geng QS, Ma WL, Ma LH, Jiang HY, Meng XP, Zhang DW, Gou XJ, Hu DY, Chen KJ. Guanxin Danshen Dripping Pills Improve Quality of Life and Cardiovascular Prognoses of CHD Patients after PCI with Anxiety or Depression (GLAD Study): A Randomized Double-Blind Placebo-Controlled Study. Chin J Integr Med 2023; 29:195-204. [PMID: 36301456 DOI: 10.1007/s11655-022-3688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of Guanxin Danshen Dripping Pills (GXDS) in the treatment of depression or anxiety in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). METHODS From September 2017 to June 2019, 200 CHD patients after PCI with depression and anxiety were included and randomly divided into GXDS (100 cases) and placebo control groups (100 cases) by block randomization and a random number table. Patients in the GXDS and control groups were given GXDS and placebo, respectively, 0.4 g each time, 3 times daily for 12 weeks. The primary outcomes were scores of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Scale (GAD-7) and the Seattle Angina Pectoris Scale (SAQ). The secondary outcomes included 12 Health Survey Summary Form (SF-12) scores and the first onset time and incidence of major adverse cardiovascular events (MACEs). Other indices including blood pressure, blood lipids, microcirculation and inflammatory-related indices, etc. were monitored at baseline, week 4, and week 12. RESULTS In the full analysis set (200 cases), after treatment, the PHQ-9 and GAD-7 scores in the GXDS group were considerably lower than those in the control group (P<0.05). Compared with the baseline, the total PHQ-9 scores of the experimental and control groups decreased by 3.97 and 1.18, respectively. The corrected mean difference between the two groups was -2.78 (95% CI: -3.47, -2.10; P<0.001). The total GAD-7 score in the GXDS group decreased by 3.48% compared with the baseline level, while that of the placebo group decreased by 1.13%. The corrected mean difference between the two groups was -2.35 (95% CI: -2.95, -1.76; P<0.001). The degree of improvement in SAQ score, SF-12 score, endothelin and high-sensitive C-reactive protein levels in the GXDS group were substantially superior than those in the placebo group, and the differences between the two groups were statistically significant (P<0.05). Similar results were obtained in the per protocol population analysis of 177 patients. Three cases of MACES were reported in this study (1 in the GXDS group and 2 in the placebo group), and no serious adverse events occurred. CONCLUSIONS GXDS can significantly alleviate depression and anxiety, relieve symptoms of angina, and improve quality of life in patients with CHD after PCI. (Registration No. ChiCTR1800014291).
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Affiliation(s)
- Cheng-Long Wang
- Department of Cardiovascular Disease, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Na Huan
- Department of Cardiovascular Disease, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Pei-Li Wang
- Department of Cardiovascular Disease, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Qing-Shan Geng
- Department of Cardiovascular Disease, Guangdong Provincial People's Hospital, Guangzhou, 510055, China
| | - Wen-Lin Ma
- Department of Cardiovascular Disease, Shanghai Tongji Hospital, Shanghai, 200065, China
| | - Li-Hong Ma
- Department of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Hong-Yan Jiang
- Department of Cardiovascular Disease, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, 100020, China
| | - Xiao-Ping Meng
- Department of Cardiovascular Disease, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, 130021, China
| | - Da-Wu Zhang
- Department of Cardiovascular Disease, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Xiao-Jiang Gou
- Department of Cardiovascular Disease, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Da-Yi Hu
- Department of Cardiovascular Disease, People's Hospital of Peking University, Beijing, 100044, China
| | - Ke-Ji Chen
- Department of Cardiovascular Disease, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China. .,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China.
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Gibson I, McCrudden Z, Dunne D, Harris A, Hynes L, Murphy E, Murphy AW, Byrne M, McEvoy JW. Harnessing digital health to optimise the delivery of guideline-based cardiac rehabilitation during COVID-19: an observational study. Open Heart 2023; 10:openhrt-2022-002211. [PMID: 36927866 PMCID: PMC10030287 DOI: 10.1136/openhrt-2022-002211] [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] [Received: 11/16/2022] [Accepted: 02/09/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic accelerated the uptake of digital health interventions for the delivery of cardiac rehabilitation (CR). However, there is a need to evaluate these interventions. METHODS We examined the impact of an evidence-based, digital CR programme on medical, lifestyle and psychosocial outcomes. Delivered by an interdisciplinary team of healthcare professionals, the core components of this 12-week programme included lifestyle modification, medical risk factor management, psychosocial and behavioural change support. To support self-management, patients were provided with a Fitbit, a home blood pressure (BP) monitor and an interactive workbook. Patients received access to a bespoke web-based platform and were invited to attend weekly, online group-based supervised exercise sessions and educational workshops. Outcomes were assessed at baseline, end of programme and at 6-month follow-up. RESULTS Over a 3-month period, 105 patients (88% with coronary heart disease) were referred with 74% (n=77) attending initial assessment. Of these, 97% (n=75) enrolled in the programme, with 85% (n=64) completing the programme, 86% (n=55) of completers attended 6-month follow-up. Comparing baseline to end of programme, we observed significant improvements in the proportion of patients meeting guideline-recommended targets for physical activity (+68%, p<0.001), BP (+44%, p<0.001) and low-density lipoprotein cholesterol (+27%, p<0.001). There were significant reductions in mean weight (-2.6 kg, p<0.001). Adherence to the Mediterranean diet score improved from 5.2 to 7.3 (p<0.001). Anxiety and depression levels (Hospital Anxiety and Depression score) both reduced by more than 50% (p<0.001). The majority of these improvements were sustained at 6-month follow-up. CONCLUSION Outcomes from this study suggest that interdisciplinary digital CR programmes can be successfully implemented and help patients achieve guideline recommended lifestyle, medical and therapeutic targets.
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Affiliation(s)
- Irene Gibson
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | | | - Denise Dunne
- Community Healthcare West, Health Service Executive West, Galway, Ireland
| | - Aisling Harris
- Croí, West of Ireland Cardiac and Stroke Foundation, Galway, Ireland
| | - Lisa Hynes
- Croí, West of Ireland Cardiac and Stroke Foundation, Galway, Ireland
| | - Ella Murphy
- School of Medicine, University of Galway, Galway, Ireland
| | | | - Molly Byrne
- Health Behaviour Change Research Group, University of Galway, Galway, Ireland
| | - John William McEvoy
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
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Dibben GO, Hillsdon M, Dalal HM, Tang LH, Doherty PJ, Taylor R. Home-based cardiac rehabilitation and physical activity in people with heart failure: a secondary analysis of the REACH-HF randomised controlled trials. BMJ Open 2023; 13:e063284. [PMID: 36759035 PMCID: PMC9923308 DOI: 10.1136/bmjopen-2022-063284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES To quantify the impact of a home-based cardiac rehabilitation intervention (Rehabilitation Enablement in Chronic Heart Failure (REACH-HF)) on objectively assessed physical activity (PA) of patients with heart failure (HF) and explore the extent by which patient characteristics are associated with a change in PA. DESIGN Secondary analysis of randomised controlled trial data. SETTING Five centres in the UK. PARTICIPANTS 247 patients with HF (mean age 70.9±10.3 years; 28% women). INTERVENTIONS REACH-HF versus usual care (control). PRIMARY AND SECONDARY OUTCOME MEASURES PA was assessed over 7 days via GENEActiv triaxial accelerometer at baseline (pre-randomisation), post-intervention (4 months) and final follow-up (6-12 months). Using HF-specific intensity thresholds, intervention effects (REACH-HF vs control) on average min/day PA (inactivity, light PA and moderate-to-vigorous PA (MVPA)) over all days, week days and weekend days were examined using linear regression analysis. Multivariable regression was used to explore associations between baseline patient characteristics and change in PA. RESULTS Although there was no difference between REACH-HF and control groups in 7-day PA levels post-intervention or at final follow-up, there was evidence of an increase in weekday MVPA (10.9 min/day, 95% CI: -2.94 to 24.69), light PA (26.9 min/day, 95% CI: -0.05 to 53.8) and decreased inactivity (-38.31 min/day, 95% CI: -72.1 to -4.5) in favour of REACH-HF. Baseline factors associated with an increase in PA from baseline to final follow-up were reduced MVPA, increased incremental shuttle walk test distance, increased Hospital Anxiety and Depression Scale anxiety score and living with a child >18 years (p<0.05). CONCLUSIONS While participation in the REACH-HF home-based cardiac rehabilitation intervention did not increase overall weekly activity, patient's behaviour patterns appeared to change with increased weekday PA levels and reduced inactivity. Baseline PA levels were highly predictive of PA change. Future focus should be on robust behavioural changes, improving overall levels of objectively assessed PA of people with HF. TRIAL REGISTRATION NUMBERS ISRCTN78539530 and ISRCTN86234930.
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Affiliation(s)
- Grace O Dibben
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Melvyn Hillsdon
- Department of Public Health and Sport Sciences, University of Exeter, Exeter, Devon, UK
| | - Hasnain M Dalal
- Research, Development and Innovation, Royal Cornwall Hospitals NHS Trust, TRURO, Cornwall, UK
- Primary Care, University of Exeter Medical School, Truro, UK
| | - Lars H Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Slagelse, Sjaelland, Denmark
- The Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | | | - Rod Taylor
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Kocanda L, Schumacher TL, Plotnikoff RC, Whatnall MC, Fenwick M, Brown LJ, Rollo ME, Jansson A, Burrows TL, Duncan MJ, Britton B, May J, Kerr J, Rutherford J, Boyle A, Inder K, Collins CE. Effectiveness and reporting of nutrition interventions in cardiac rehabilitation programmes: a systematic review. Eur J Cardiovasc Nurs 2023; 22:1-12. [PMID: 35672581 DOI: 10.1093/eurjcn/zvac033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 01/14/2023]
Abstract
AIMS Dietary modification is essential for the secondary prevention of cardiovascular disease. However, there are limited published evidence syntheses to guide practice in the cardiac rehabilitation (CR) setting. This systematic review's objective was to assess effectiveness and reporting of nutrition interventions to optimize dietary intake in adults attending CR. METHODS AND RESULTS Randomized controlled trials (RCTs) of nutrition interventions within CR were eligible for inclusion and had to have measured change in dietary intake. MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Scopus, and The Cochrane Library were searched from 2000 to June 2020, limited to publications in English. Evidence from included RCTs was synthesized descriptively. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. This review is registered on PROSPERO; CRD42020188723. Of 13 048 unique articles identified, 11 were eligible. Randomized controlled trials were conducted in 10 different countries, included 1542 participants, and evaluated 29 distinct dietary intake outcomes. Five studies reported statistically significant changes in diet across 13 outcomes. Most nutrition interventions were not reported in a manner that allowed replication in clinical practice or future research. CONCLUSION There is a gap in research testing high-quality nutrition interventions in CR settings. Findings should be interpreted in the light of limitations, given the overall body of evidence was heterogenous across outcomes and study quality; 6 of 11 studies were conducted more than 10 years old. Future research should investigate strategies to optimize and maintain nutrition improvements for patients attending CR. REGISTRATION PROSPERO; CRD42020188723.
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Affiliation(s)
- Lucy Kocanda
- Department of Rural Health, University of Newcastle, Tamworth, NSW 2340, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Tracy L Schumacher
- Department of Rural Health, University of Newcastle, Tamworth, NSW 2340, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Ronald C Plotnikoff
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Megan C Whatnall
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Matthew Fenwick
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Leanne J Brown
- Department of Rural Health, University of Newcastle, Tamworth, NSW 2340, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Megan E Rollo
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Anna Jansson
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Tracy L Burrows
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Mitch J Duncan
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Ben Britton
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jennifer May
- Department of Rural Health, University of Newcastle, Tamworth, NSW 2340, Australia
| | - Jane Kerr
- Hunter New England Local Health District, Tamworth, NSW 2340, Australia
| | - Julie Rutherford
- Hunter New England Local Health District, Maitland, NSW 2320, Australia
| | - Andrew Boyle
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Kerry Inder
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia.,School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
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Khushhal A, Alsubaiei M. Barriers to Establishing Outpatient Cardiac Rehabilitation in the Western Region of Saudi Arabia: A Cross-Sectional Study. J Multidiscip Healthc 2023; 16:653-661. [PMID: 36923361 PMCID: PMC10010741 DOI: 10.2147/jmdh.s398687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
Abstract
Background The core of cardiac rehabilitation (CR) is structured exercise training. CR reduces 28-56% hospital readmission rate, and around 25% increases cardiorespiratory fitness but the number of outpatients CR centers in Saudi Arabia (SA) is very limited and there is a need to establish outpatient CR (Phase III) in SA. Furthermore, the awareness of outpatient CR in SA is unknown. Aim To determine the main barriers to establishing an outpatient CR program (Phase III) in the western region of SA, as well as assess the awareness of outpatient CR (Phase III) in the western region of SA. Methods A cross-sectional study survey was conducted between March - July 2021 among physiotherapists, cardiologists and the cardiac surgeon using a questionnaire distributed electronically to determine the awareness level of outpatient CR and barriers to establishing outpatient CR (Phase III) in the western region of SA. Frequencies and percentages were used to report the variables. Results Of the 141 participants who completed the online survey, our findings showed that 131 (93%) were aware of CR but only 29 (21%) were aware of the four phases of CR. There were three main barriers to establishing CR: lack of appropriate CR 135 (96%); lack of awareness among healthcare professions of CR and its benefits 134 (95%) and the lack of healthcare providers trained in CR 133 (94%). There was a significant relationship between physiotherapists and cardiologists' responses on agreeing to all barriers to establishing CR in SA (r=0.69, P =0.03). Conclusion To overcome the barriers to establishing CR outpatient centers in the western region of SA, it is recommended to provide more CR outpatient training programs to healthcare providers and raise the awareness of the CR phases, its benefits, and the risk factors for developing cardiac diseases among healthcare providers.
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Affiliation(s)
- Alaa Khushhal
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Mohammed Alsubaiei
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Imam Abulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
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45
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Yin Ong JS, Lin W, Yeo TJ. The Role of Exercise-based Cardiac Rehabilitation in Heart Failure. Curr Pharm Des 2023; 29:494-501. [PMID: 36799421 DOI: 10.2174/1381612829666230217145100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/18/2022] [Accepted: 12/29/2022] [Indexed: 02/18/2023]
Abstract
Exercise-based cardiac rehabilitation (EBCR) is a treatment modality for patients with heart failure (HF) that has withstood the test of time. It has continued to show benefits even in the current era of pharmacotherapeutics for HF. Participation in a multidisciplinary comprehensive EBCR programme reduces mortality and morbidity, has a multitude of physiological benefits, and improves cardiovascular risk factor control and quality of life. Despite this, historical barriers to enrolment and uptake remain. Strategies to overcome these, as well as alternative delivery methods of EBCR in HF patients, are emerging and include telerehabilitation, focus on special groups and emphasis on behavioural change. This review provides oversight on the modalities of exercise training in HF as well as their benefits and gives an overview of barriers to the utilisation of EBCR along with future progress in the field.
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Affiliation(s)
- Jeanne Shan Yin Ong
- Cardiac Department , National University Heart Centre,1E Kent Ridge Road, Level 9, Singapore
| | - Weiqin Lin
- Cardiac Department , National University Heart Centre,1E Kent Ridge Road, Level 9, Singapore
| | - Tee Joo Yeo
- Cardiac Department , National University Heart Centre,1E Kent Ridge Road, Level 9, Singapore
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46
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Vladimirsky VE, Vladimirsky EV, Lebedeva OD, Fesyun AD, Yakovlev MY, Lunina AN. [Cardiac rehabilitation: investigation of efficacy, results, perspectives]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2023; 100:45-55. [PMID: 38016056 DOI: 10.17116/kurort202310005145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Previous research experience on cardiac rehabilitation programs as a part of general health care system has shown that they are an important part of the management of cardiovascular patients. Improving quality of life, reducing the severity of risk factors, increasing physical performance, slowing disease progression, decrease in morbidity and mortality indicate the clinical efficacy of cardiac rehabilitation and make it an integral part of therapeutic interventions. Heart rehabilitation is a 1st class recommendation in the majority of modern cardiovascular guidelines around the world.
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Affiliation(s)
| | | | - O D Lebedeva
- National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia
| | - A D Fesyun
- National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia
| | - M Yu Yakovlev
- National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia
| | - A N Lunina
- E.A. Wagner Perm State Medical University, Perm, Russia
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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.
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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
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Aldhahir AM, Alhotye M, Alqahtani JS, AlDraiwiesh IA, Alghamdi SM, Alsulayyim AS, Alqarni AA, Khormi SK, Alzahrani EM, Al Rajeh AM, Aldabayan YS, Siraj RA, Tawhari NA, Alhazmi FM, Najmi AA, Alwadeai KS, Alwafi H. Physiotherapists' Attitudes, and Barriers of Delivering Cardiopulmonary Rehabilitation for Patients with Heart Failure in Saudi Arabia: A Cross-Sectional Study. J Multidiscip Healthc 2022; 15:2353-2361. [PMID: 36267851 PMCID: PMC9578487 DOI: 10.2147/jmdh.s386519] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/07/2022] [Indexed: 12/12/2022] Open
Abstract
Background Cardiopulmonary rehabilitation (CR) is an effective management approach for heart failure (HF) patients and is delivered by multidisciplinary teams including physiotherapists (PTs). PT attitudes about delivering CR and barriers that might affect referral have not been explored. Thus, this study is aimed to explore PT attitudes about delivering CR programs to patients with HF and identify factors and barriers that might affect referral decisions. Methods A cross-sectional online survey was disseminated to all PTs in Saudi Arabia between 19 February and 27 June, 2022. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. Results Overall, 553 PTs, 289 (52.30%) male and 264 (47.70%) females, completed the online survey. Of these, 360 (65.1%) strongly agreed that CR would improve patients’ physical fitness and 334 (60.4%) strongly agreed that CR would reduce breathlessness in patients with HF. The majority of PTs (321, 58%) strongly agreed that CR would improve HF patients’ palpitation and fatigue. Out of 553 PTs, 349 (63.1%) strongly agreed that CR would improve patients’ ability to perform daily activities. A hospital-supervised program was the preferred mode of delivering CR programs by 499 (90.20%) of the respondents. Apart from the exercise component, stress management was perceived by 455 (82.30%) as an essential component of CR programs. The most common patient-related factor that strongly influenced referral decisions was “fatigue related to disease” (42%). A lack of CR centers was reported by 59.90% as the most common referring barrier. Conclusion PTs perceived CR as a successful strategy for patients with HF. Although a supervised hospital-based program with stress management as an essential component aside from the exercise component was perceived as the preferred mode of delivery, CR was lacking, which caused a significant barrier to CR referral from the PTs’ perspective.
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Affiliation(s)
- Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Munyra Alhotye
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Ibrahim A AlDraiwiesh
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Saeed M Alghamdi
- Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Abdullah S Alsulayyim
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shahad K Khormi
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Eidan M Alzahrani
- Department of Physiotherapy, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Ahmed M Al Rajeh
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Yousef S Aldabayan
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Rayan A Siraj
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Faisal University, Al-Hasa, Saudi Arabia
| | - Naif A Tawhari
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Faisal M Alhazmi
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Ayat A Najmi
- Physical Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Khalid S Alwadeai
- Rehabilitation Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
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Aldhahir AM. Nurses' Perception of, and Barriers to, Delivering Cardiopulmonary Rehabilitation for Heart Failure Patients: A National Survey in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13586. [PMID: 36294165 PMCID: PMC9602745 DOI: 10.3390/ijerph192013586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Heart failure (HF) patients require a holistic management approach to improve their clinical outcomes. Cardiopulmonary rehabilitation (CR) is a core component of HF patients' management and is supervised by a multidisciplinary team including nurses. Nursing attitudes regarding CR delivery for patients with HF and the possible barriers and factors that potentially affect referral have not been explored. Therefore, this study seeks to evaluate nurses' attitudes towards the delivery of CR programs and the possible barriers and factors that potentially influence the decision for a referral. METHODS An online survey with eight multiple-choice items was disseminated to all nurses between February and July 2022 in Saudi Arabia. The characteristics of the respondents were described using descriptive statistics. Percentages and frequencies were used to report categorical variables. RESULTS Overall, 1056 nurses completed the online survey, of which 395 (37.40%) were male. Out of 1056 nurses, 414 (39.20%) strongly agreed that CR would improve patients' physical fitness, and 392 (37.10%) strongly agreed that CR would reduce breathlessness in patients with HF. In total, 381 nurses strongly agreed (36.10%) that CR would improve HF patients' palpitation and fatigue. Out of 1056 nurses, 396 (37.50%) strongly agreed that CR would improve HF patients' ability to perform daily activities, and 326 (30.90%) strongly agreed that CPR would reduce the rate of hospital readmission. The at-home program was the preferred mode of delivering CR programs among 607 (57.50%) nurses. Apart from the exercise component, symptom management was perceived by 704 (66.70%) nurses as the fundamental component of CR programs. The most common patient-related factor that strongly affected the decisions regarding referral was "mobility affected by breathlessness" (57%). A lack of CR centers (46%) was the most common barrier. CONCLUSION Nurses perceived CR as an effective management strategy for HF patients. Although a home-based program, with symptom management being an essential component, in addition to the exercise component, was perceived as the preferred mode of delivery, CR centers are lacking, which represented a significant barrier to CR referral from the nurses' perspective.
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Affiliation(s)
- Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
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Yu T, Xu H, Sui X, Zhang X, Pang Y, Yu T, Lian X, Zeng T, Wu Y, Leng X, Li F. The effectiveness of eHealth interventions on moderate-to-vigorous intensity physical activity among cardiac rehabilitation participants: a systematic review and meta-analysis (Preprint). J Med Internet Res 2022; 25:e42845. [PMID: 36989017 PMCID: PMC10131595 DOI: 10.2196/42845] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/27/2022] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation is a class IA recommendation for patients with cardiovascular diseases. Physical activity is the core component and core competency of a cardiac rehabilitation program. However, many patients with cardiovascular diseases are failing to meet cardiac rehabilitation guidelines that recommend moderate-to-vigorous intensity physical activity. OBJECTIVE The major objective of this study was to review the evidence of the effectiveness of eHealth interventions in increasing moderate-to-vigorous intensity physical activity among patients in cardiac rehabilitation. The secondary objective was to examine the effectiveness of eHealth interventions in improving cardiovascular-related outcomes, that is, cardiorespiratory fitness, waist circumference, and systolic blood pressure. METHODS A comprehensive search strategy was developed, and a systematic search of 4 electronic databases (PubMed, Web of Science, Embase, and Cochrane Library) was conducted for papers published from the start of the creation of the database until November 27, 2022. Experimental studies reporting on eHealth interventions designed to increase moderate-to-vigorous intensity physical activity among patients in cardiac rehabilitation were included. Multiple unblinded reviewers determined the study eligibility and extracted data. Risk of bias was evaluated using the Cochrane Collaboration Tool for randomized controlled trials and the Cochrane Effective Practice and Organization of Care group methods for nonrandomized controlled trials. A random-effect model was used to provide the summary measures of effect (ie, standardized mean difference and 95% CI). All statistical analyses were performed using Stata 17. RESULTS We screened 3636 studies, but only 29 studies were included in the final review, of which 18 were included in the meta-analysis. The meta-analysis demonstrated that eHealth interventions improved moderate-to-vigorous intensity physical activity (standardized mean difference=0.18, 95% CI 0.07-0.28; P=.001) and vigorous-intensity physical activity (standardized mean difference=0.2, 95% CI 0.00-0.39; P=.048) but did not improve moderate-intensity physical activity (standardized mean difference=0.19, 95% CI -0.12 to 0.51; P=.23). No changes were observed in the cardiovascular-related outcomes. Post hoc subgroup analyses identified that wearable-based, web-based, and communication-based eHealth intervention delivery methods were effective. CONCLUSIONS eHealth interventions are effective at increasing minutes per week of moderate-to-vigorous intensity physical activity among patients in cardiac rehabilitation. There was no difference in the effectiveness of the major eHealth intervention delivery methods, thereby providing evidence that in the future, health care professionals and researchers can personalize convenient and affordable interventions tailored to patient characteristics and needs to eliminate the inconvenience of visiting center-based cardiac rehabilitation programs during the COVID-19 pandemic and to provide better support for home-based maintenance of cardiac rehabilitation. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021278029; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278029.
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Affiliation(s)
- Tianzhuo Yu
- School of Nursing, Jilin University, Changchun, China
| | - Haiyan Xu
- School of Nursing, Jilin University, Changchun, China
| | - Xin Sui
- School of Nursing, Jilin University, Changchun, China
| | - Xin Zhang
- School of Nursing, Jilin University, Changchun, China
| | - Yue Pang
- School of Nursing, Jilin University, Changchun, China
| | - Tianyue Yu
- School of Nursing, Jilin University, Changchun, China
| | - Xiaoqian Lian
- School of Nursing, Jilin University, Changchun, China
| | - Ting Zeng
- School of Nursing, Jilin University, Changchun, China
| | - Yuejin Wu
- School of Nursing, Jilin University, Changchun, China
| | - Xin Leng
- School of Nursing, Jilin University, Changchun, China
| | - Feng Li
- School of Nursing, Jilin University, Changchun, China
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