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Wittboldt S, Leosdottir M, Ravn Fischer A, Ekman B, Bäck M. Exercise-based cardiac rehabilitation after acute myocardial infarction in Sweden - standards, costs, and adherence to European guidelines (The Perfect-CR study). Physiother Theory Pract 2024; 40:366-376. [PMID: 36047009 DOI: 10.1080/09593985.2022.2114052] [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] [Received: 01/13/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
AIMS Information on standards including structure- and process-based metrics and how exercise-based cardiac rehabilitation (EBCR) is delivered in relation to guidelines is lacking. The aims of the study were to evaluate standards and adherence to guidelines at Swedish CR centers and to conduct a cost analysis of the physiotherapy-related activities of EBCR. METHODS AND RESULTS EBCR standards at all 78 CR centers in Sweden in 2016 were surveyed. The questions were based on guideline-recommended core components of EBCR for patients after a myocardial infarction (MI). The cost analysis included the identification, quantification, and valuation of EBCR-related cost items. Patients were offered a pre-discharge consultation with a physiotherapist at n = 61, 78% of the centers. A pre-exercise screening visit was routinely offered at n = 64, 82% of the centers, at which a test of aerobic capacity was offered in n = 58, 91% of cases, most often as a cycle ergometer exercise test n = 55, 86%. A post-exercise assessment was offered at n = 44, 56% of the centers, with a functional test performed at n = 30, 68%. Almost all the centers n = 76, 97% offered supervised EBCR programs. The total cost of delivering physiotherapy-related activities of EBCR according to guidelines was approximately 437 euro (4,371 SEK) per patient. Delivering EBCR to one MI patient required 11.25 hours of physiotherapy time. CONCLUSION While the overall quality of EBCR programs in Sweden is high, there are several areas of potential improvement to reach the recommended European standards across all centers. To improve the quality of EBCR, further compliance with guidelines is warranted.
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Affiliation(s)
- Susanna Wittboldt
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Annica Ravn Fischer
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Ekman
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Maria Bäck
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
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2
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Wang L, Liu J, Fang H, Wang X. Factors associated with participation in cardiac rehabilitation in patients with acute myocardial infarction: A systematic review and meta-analysis. Clin Cardiol 2023; 46:1450-1457. [PMID: 37594292 PMCID: PMC10642335 DOI: 10.1002/clc.24130] [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: 06/29/2023] [Revised: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is effective in reducing morbidity and mortality in patients with acute myocardial infarction (AMI), but the participation rate is low and its influencing factors vary. Our study aimed to systematically review the literature and investigate the participation rates and influencing factors of CR in patients with AMI. METHODS We searched 10 databases, including PubMed, Web of Science, Cochrane Library, and so forth. A systematic review and meta-analysis were conducted on the studies on the factors affecting CR participation in AMI. The Q tests and the I2 tests were used to assess heterogeneity between studies. The combined effect size and odds ratio (OR) and their respective 95% confidence interval (CI) for CR participation rate and its influences are expressed, respectively. Stata 17.0 software was used for statistical analysis. RESULTS We included 14 studies with 114 542 participants. Current evidence indicates a CR participation rate of 34% (95% CI: 21%-46%) in patients with AMI. The pooled OR values and CI of each influencing factor are as follows: over 60 years old (OR = 0.865; 95% CI: 0.772-0.969), male (OR = 1.690; 95% CI: 1.276-2.239), college education or above (OR = 2.526; 95% CI: 1.117-5.711), ST-segment elevation myocardial infarction (OR = 4.257; 95% CI: 2.004-9.045), decrease in left ventricular ejection fraction (OR = 0.918; 95% CI: 0.868-0.971), higher economic level (OR = 1.282; 95% CI: 1.108-1.483), history of coronary heart disease(OR = 0.667; 95% CI: 0.509-0.875), smoking (OR = 0.665; 95% CI: 0.550-0.805), combined hypertension (OR = 0.638; 95% CI: 0.562-0.723), and combined hyperlipidemia (OR = 0.577; 95% CI: 0.512-0.651). CONCLUSIONS The overall participation rate of CR in AMI patients is low, and various factors affect the participation rate. Specialist medical staff are needed to further promote CR rehabilitation concepts and scientific knowledge, and take appropriate measures to address the influencing factors to increase CR utilization and improve patient prognosis.
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Affiliation(s)
- Lingyu Wang
- Nursing SchoolAnhui University of Chinese MedicineHefeiAnhuiChina
| | - Jingyu Liu
- Nursing SchoolAnhui University of Chinese MedicineHefeiAnhuiChina
| | - Haiyan Fang
- Nursing SchoolAnhui University of Chinese MedicineHefeiAnhuiChina
| | - Xiang Wang
- Nursing SchoolAnhui University of Chinese MedicineHefeiAnhuiChina
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3
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Gallagher R, Cartledge S, Zwack C, Hollings M, Zhang L, Gauci S, Gordon N, Zecchin R, O'Neil A, Tirimacco R, Phillips S, Astley C, Briffa T, Hyun K, Chaseling GK, Candelaria D, Redfern J. A National Survey of Patient Data Capture, Management, Reporting Practice in Australian Cardiac Rehabilitation Programs. Heart Lung Circ 2023; 32:1361-1368. [PMID: 37891145 DOI: 10.1016/j.hlc.2023.09.013] [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: 04/16/2023] [Revised: 07/29/2023] [Accepted: 09/12/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Lack of service data for cardiac rehabilitation limits understanding of program delivery, benchmarking and quality improvement. This study aimed to describe current practices, management, utilisation and engagement with quality indicators in Australian programs. METHOD Cardiac rehabilitation programs (n=396) were identified from national directories and networks. Program coordinators were surveyed on service data capture, management systems and adoption of published national quality indicators. Text responses were coded and classified. Logistic regression determined independent associates of the use of data for quality improvement. RESULTS A total of 319 (81%) coordinators completed the survey. Annual patient enrolments/programs were >200 (31.0%), 51-200 (46%) and ≤50 (23%). Most (79%) programs used an electronic system, alongside paper (63%) and/or another electronic system (19%), with 21% completely paper. While 84% knew of the national quality indicators, only 52% used them. Supplementary to patient care, data were used for reports to managers (57%) and funders (41%), to improve quality (56%), support funding (43%) and research (31%). Using data for quality improvement was more likely when enrolments where >200 (Odds ratio [OR] 3.83, 95% Confidence Interval [CI] 1.76-8.34) and less likely in Victoria (OR 0.24 95%, CI 0.08-0.77), New South Wales (OR 0.25 95%, CI 0.08-0.76) and Western Australia (OR 0.16 95%, CI 0.05-0.57). CONCLUSIONS The collection of service data for cardiac rehabilitation patient data and its justification is diverse, limiting our capacity to benchmark and drive clinical practice. The findings strengthen the case for a national low-burden approach to data capture for quality care.
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Affiliation(s)
- Robyn Gallagher
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Susie Cartledge
- Faculty of Medicine, Nursing and Health Sciences Monash University, Melbourne, Vic, Australia
| | - Clara Zwack
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Matthew Hollings
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ling Zhang
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sarah Gauci
- Faculty of Health Deakin University, Deakin University, Victoria, Australia
| | - Nicole Gordon
- Heart Health and Fitness Western Australia, Perth, WA, Australia
| | - Robert Zecchin
- Western Sydney Local Health District, Sydney, NSW, Australia
| | - Adrienne O'Neil
- Faculty of Health Deakin University, Deakin University, Victoria, Australia
| | - Rosy Tirimacco
- Integrated Cardiovascular Clinical Network Country Health South Australia (iCCnet SA), Adelaide, SA, Australia
| | | | - Carolyn Astley
- South Australian Academic Health Science and Translation Centre, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Tom Briffa
- School of Population and Global Health University of Western Australia, University of Western Australia, Perth, WA, Australia
| | - Karice Hyun
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; ANZAC Research Institute, Department of Cardiology, Concord Hospital, Sydney, NSW, Australia
| | - Georgia K Chaseling
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Dion Candelaria
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Julie Redfern
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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4
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Gutierrez-Arias R, Neculhueque-Zapata X, Valenzuela-Suazo R, Oliveros MJ, Morales C, Vásquez L, Jalil Y, Marzuca-Nassr GN, Inostroza Quiroz JL, Fuentes-Aspe R, Solano R, Salgado-Maldonado G, Aguilera-Eguía R, Águila-Villanueva C, Garcés-Burgos C, Seron P. Assessment of activities and participation of people by rehabilitation-focused clinical registries: a systematic scoping review. Eur J Phys Rehabil Med 2023; 59:640-652. [PMID: 37721783 PMCID: PMC10664814 DOI: 10.23736/s1973-9087.23.07895-4] [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: 01/26/2023] [Revised: 07/11/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Rehabilitation is considered a key intervention in health care. Clinical registries, defined as an organized system that uses observational methods to collect information to assess specific outcomes in a defined population, can contribute to assessing the impact of the rehabilitation intervention. This review aims to identify and describe rehabilitation-specific registry systems with an emphasis on identifying outcomes that enable the assessment of vital areas and activities of daily living. EVIDENCE ACQUISITION A systematic scoping review was conducted. A systematic search was conducted up to August 2022 in MEDLINE/PubMed, Embase, Cochrane Library, Epistemonikos, and other search resources. Studies related to rehabilitation registries presented data on people with health problems that could limit their functioning were selected. The inclusion of studies/clinical registries was not limited by methodological design, year of publication, country, or language. The unit of analysis was rehabilitation registries. The measurement instruments used to assess the outcomes were explored to estimate the domain assessed from the vital areas related to functioning and disability as described by the International Classification of Functioning, Disability and Health (ICF). The vital areas were classified according to activities of daily living (ADLs). EVIDENCE SYNTHESIS Seventy-one registries in rehabilitation were identified. The registries included a median of 3 (IQR 2-5) assessment instruments designed to assess the impact of different rehabilitation programs. In total, 137 different assessment scales or instruments were identified. Each rehabilitation registry assessed 6 (IQR 2-8) domains of the ICF, and 15.4% of registries assessed all domains. The most assessed domain was "Mobility" (89.7%), and the least assessed was "General Tasks and Demands" (25.6%). In addition, 92.3% of rehabilitation registries assessed basic ADLs, 76.9% advanced ADLs, and 71.8% instrumental ADLs. CONCLUSIONS Although clinical registries do not claim to directly assess the impact of rehabilitation programs on people's functioning according to the ICF framework, it was identified that a low percentage of them assessed the nine vital areas through different outcome assessment instruments. However, most rehabilitation registries directly or indirectly assess some basic, instrumental, and advanced ADLs. The findings of this review highlight the need to improve the design of clinical registries focused on assessing the impact of rehabilitation programs to assess people in all areas of their lives.
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Affiliation(s)
- Ruvistay Gutierrez-Arias
- Department of Support in Integral Cardiopulmonary Rehabilitation, National Thorax Institute, Santiago, Chile
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Andres Bello University, Santiago, Chile
- INTRehab Research Group, Instituto Nacional del Tórax, Santiago, Chile
| | - Ximena Neculhueque-Zapata
- Department of Rehabilitation and Disability, Subsecretary of Public Health, Ministry of Health, Santiago, Chile
| | - Raúl Valenzuela-Suazo
- Department of Rehabilitation and Disability, Subsecretary of Public Health, Ministry of Health, Santiago, Chile
| | - Maria-Jose Oliveros
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile
- CIGES Center of Excellence, University of La Frontera, Temuco, Chile
| | - Camilo Morales
- Department of Therapeutical Protocols, Faculty of Health Sciences, Catholic University of Temuco, Temuco, Chile
| | - Luis Vásquez
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile
| | - Yorschua Jalil
- Department of Intensive Care Medicine, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
- Department of Kinesiology, Pontifical Catholic University of Chile, Santiago, Chile
| | - Gabriel N Marzuca-Nassr
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile
| | | | - Rocío Fuentes-Aspe
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile
- CIGES Center of Excellence, University of La Frontera, Temuco, Chile
| | - Ricardo Solano
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile
| | - Gabriel Salgado-Maldonado
- Department of Support in Integral Cardiopulmonary Rehabilitation, National Thorax Institute, Santiago, Chile
- INTRehab Research Group, Instituto Nacional del Tórax, Santiago, Chile
- Laboratory of Cognitive Neurosciences (LANNEC), Clinic of Memory and Neuropsychiatry (CMYN), University of Chile, Santiago, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile
| | - Raúl Aguilera-Eguía
- Department of Public Health, Faculty of Medicine, Catholic University of Santísima Concepción, Concepción, Chile
| | - Camilo Águila-Villanueva
- Department of Rehabilitation and Disability, Subsecretary of Public Health, Ministry of Health, Santiago, Chile
| | - Carolina Garcés-Burgos
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile
| | - Pamela Seron
- Department of Rehabilitation Sciences, Faculty of Medicine, University of La Frontera, Temuco, Chile -
- CIGES Center of Excellence, University of La Frontera, Temuco, Chile
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Grace SL, Elashie S, Sadeghi M, Papasavvas T, Hashmi F, de Melo Ghisi G, Vargas JL, Al-Hashemi M, Turk-Adawi K. Pilot testing of the International Council of Cardiovascular Prevention and Rehabilitation Registry. Int J Qual Health Care 2023; 35:mzad050. [PMID: 37421311 PMCID: PMC10329404 DOI: 10.1093/intqhc/mzad050] [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: 02/04/2023] [Revised: 06/06/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023] Open
Abstract
The International Council of Cardiovascular Prevention and Rehabilitation developed an International Cardiac Rehabilitation (CR) Registry (ICRR) to support CR programs in low-resource settings to optimize care provision and patient outcomes. This study assessed implementation of the ICRR, site data steward experience with on-boarding and data entry, and patient acceptability. Multimethod observational pilot involves (I) analysis of ICRR data from three centers (Iran, Pakistan, and Qatar) from inception to May 2022, (II) focus group with on-boarded site data stewards (also from Mexico and India), and (III) semistructured interviews with participating patients. Five hundred sixty-seven patients were entered. Based on volumes at each program, 85.6% of patients were entered in ICRR. 99.3% patients approached consented to participate. The average time to enter data at pre- and follow-up assessments by source was 6.8-12.6 min. Of 22 variables preprogram, completion was 89.5%. Among patients with any follow-up data, of four program-reported variables, completion was 99.0% in program completers and 51.5% in none; of 10 patient-reported variables, completion was 97.0% in program completers and 84.8% in none. The proportion of patients with any follow-up data was 84.8% in program completers, with 43.6% of noncompleters having any data entered other than completion status. Twelve data stewards participated in the focus group. Main themes were valuable on-boarding process, data entry, process of engaging patients, and benefits of participation. Thirteen patients were interviewed. Themes were good understanding of the registry, positive experience providing data, and value of lay summary and eagerness for annual assessment. Feasibility and data quality of ICRR were demonstrated.
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Affiliation(s)
- Sherry L Grace
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada
- KITE Research Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Sana Elashie
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Theodoros Papasavvas
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Farzana Hashmi
- Department of Rheumatology, Fatima Memorial Hospital & FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Gabriela de Melo Ghisi
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada
| | - Jorge Lara Vargas
- Servicio de Rehabilitación Cardiaca, Departamento de Cardiocirugía, Centro Médico Nacional 20 de Noviembre, Ciudad de México 03104, México
| | - Mohammed Al-Hashemi
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Karam Turk-Adawi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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Grace SL, Taylor RS, Gaalema DE, Redfern J, Kotseva K, Ghisi G. Cardiac Rehabilitation: A Global Perspective on Where We Have Come and Where We Must Go. JACC. ADVANCES 2023; 2:100412. [PMID: 38938991 PMCID: PMC11198422 DOI: 10.1016/j.jacadv.2023.100412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Sherry L. Grace
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rod S. Taylor
- Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, School of Health and Well Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Diann E. Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, USA
| | - Julie Redfern
- Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Sydney, Australia
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland-Galway, Galway, Ireland
| | - Gabriela Ghisi
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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7
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Leosdottir M, Hagstrom E, Hadziosmanovic N, Norhammar A, Lindahl B, Hambraeus K, Jernberg T, Bäck M. Temporal trends in cardiovascular risk factors, lifestyle and secondary preventive medication for patients with myocardial infarction attending cardiac rehabilitation in Sweden 2006-2019: a registry-based cohort study. BMJ Open 2023; 13:e069770. [PMID: 37173109 DOI: 10.1136/bmjopen-2022-069770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES Registries have been highlighted as means to improve quality of care. Here, we describe temporal trends in risk factors, lifestyle and preventive medication for patients after myocardial infarction (MI) registered in the quality registry Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). DESIGN A registry-based cohort study. SETTING All coronary care units and cardiac rehabilitation (CR) centres in Sweden. PARTICIPANTS Patients attending a CR visit at 1-year post-MI 2006-2019 were included (n=81 363, 18-74 years, 74.7% men). OUTCOME MEASURES Outcome measures at 1-year follow-up included blood pressure (BP) <140/90 mm Hg, low-density lipoprotein-cholesterol (LDL-C)<1.8 mmol/L, persistent smoking, overweight/obesity, central obesity, diabetes prevalence, inadequate physical activity, and prescription of secondary preventive medication. Descriptive statistics and testing for trends were applied. RESULTS The proportion of patients attaining the targets for BP<140/90 mmHg increased from 65.2% (2006) to 86.0% (2019), and LDL-C<1.8 mmol/L from 29.8% (2006) to 66.9% (2019, p<0.0001 both). While smoking at the time of MI decreased (32.0% to 26.5%, p<0.0001), persistent smoking at 1 year was unchanged (42.8% to 43.2%, p=0.672) as was the prevalence of overweight/obesity (71.9% to 72.9%, p=0.559). Central obesity (50.5% to 57.0%), diabetes (18.2% to 27.2%) and patients reporting inadequate levels of physical activity (57.0% to 61.5%) increased (p<0.0001 for all). From 2007, >90.0% of patients were prescribed statins and approximately 98% antiplatelet and/or anticoagulant therapy. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker prescription increased from 68.7% (2006) to 80.2% (2019, p<0.0001). CONCLUSIONS While little change was observed for persistent smoking and overweight/obesity, large improvements were observed for LDL-C and BP target achievements and prescription of preventive medication for Swedish patients after MI 2006-2019. Compared with published results from patients with coronary artery disease in Europe during the same period, these improvements were considerably larger. Continuous auditing and open comparisons of CR outcomes might possibly explain some of the observed improvements and differences.
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Affiliation(s)
- Margret Leosdottir
- Department of Cardiology, Skane University Hospital, Malmo, Sweden
- Department of Clinical Sciences Malmo, Lund University, Malmo, Sweden
| | - Emil Hagstrom
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala, Sweden
| | | | - Anna Norhammar
- Department of Medicine Solna, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden
- Capio Sankt Gorans Sjukhus, Stockholm, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala, Sweden
| | | | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - Maria Bäck
- Department of Medical and Health Sciences, Division of Physiotherapy, Linkoping University, Linkoping, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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8
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Nabovati E, Farzandipour M, Sadeghi M, Sarrafzadegan N, Noohi F, Sadeqi Jabali M. A Global Overview of Acute Coronary Syndrome Registries: A Systematic Review. Curr Probl Cardiol 2023; 48:101049. [PMID: 34780868 DOI: 10.1016/j.cpcardiol.2021.101049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 12/16/2022]
Abstract
The present study was conducted with the aim of identifying, and summarizing the characteristics of ACS registries at national, multinational and international levels. Literature was searched using keywords in the title and/or abstract without any time limit ending in March, 2021. After excluding duplicates, 2 reviewers independently reviewed the titles and/or abstracts and full text for inclusion. Each reviewer independently extracted the characteristics of the registries from included papers. Finally, the extracted characteristics were confirmed by a second reviewer. Out of the 1309 papers included, 71 ACS registries were identified (including 60 national and 11 multinational and international registries). Most national registries were being used in Europe. Most registries focused on measuring quality. In more than half of the registries, all types of ACS patients were enrolled. The diagnostic and drug classification systems were mentioned in eight and five registries, respectively. The design of 55 registries was hospital-based. The ability of computerized audit checks was made for 34 registries. More than half of the registries had patient consent and had a web-based design. In all the ACS registries, patient characteristics, clinical characteristics and treatment characteristics were recorded and post-discharge follow-up information was recorded in 45 registries. In the current situation and given that a limited number of countries in the world have national ACS registries, reviewing the results of this study and modeling the registries implemented in the leading countries can help countries without a registry to design it.
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Affiliation(s)
- Ehsan Nabovati
- Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran
| | - Mehrdad Farzandipour
- Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran.
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Feridoun Noohi
- Iranian Network of Cardiovascular Research, Iran; Cardiovascular Intervention Research Center, Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Monireh Sadeqi Jabali
- Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran.
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9
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Phillips S, Vollbon W, Kidby K, Thomas EE. Improving Cardiac Rehabilitation in Queensland: A Whole of System, Data-Driven Approach Over the Past 10 Years. Heart Lung Circ 2022; 31:1568-1572. [PMID: 36163315 DOI: 10.1016/j.hlc.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/16/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Samara Phillips
- Clinical Improvement Unit, Metro South Health, Woolloongabba, Qld, Australia.
| | - William Vollbon
- Statewide Cardiac Clinical Informatics Unit, Queensland Government Department of Health, Brisbane, Qld, Australia
| | - Kylie Kidby
- Health Improvement Unit, Clinical Excellence Queensland, Queensland Government Department of Health, Brisbane, Qld, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Brisbane, Qld, Australia; Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
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10
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Kida K, Nishitani-Yokoyama M, Shimada K, Daida H, Ushijima A, Kono Y, Miura M, Itoh H, Sakata Y, Nagayama M, Furukawa Y, Fukuma N, Izawa H, Ohya Y, Saku K, Miura SI, Goto Y, Itoh H, Makita S. Study Design of the Japanese Association of Cardiac Rehabilitation Registry (J-CARRY) ― Protocol for a Prospective, Multicenter, Open Registry ―. Circ Rep 2022; 4:550-554. [PMID: 36408356 PMCID: PMC9638515 DOI: 10.1253/circrep.cr-22-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/26/2022] [Accepted: 09/14/2022] [Indexed: 11/11/2022] Open
Abstract
Background: Guidelines for the prevention and management of cardiovascular disease (CVD) highly recommend cardiac rehabilitation (CR) on the basis of abundant evidence of its effectiveness. However, the current understanding and dissemination of CR in Japan are far from sufficient. Methods and Results: The Japanese Association of Cardiac Rehabilitation Registry (J-CARRY) is an academic society-led prospective multicenter observational registry conducted by the Registration and Facility Accreditation System Committee of the Japanese Association of Cardiac Rehabilitation. Data are collected prospectively using an electronic data capture system. Items related to patients’ clinical background and CR, as well as mortality and major adverse cardiac and cerebrovascular events, will be collected in all cases. This Registry started in May 2014, and the number of participating medical institutions is expected to increase to >30; the targeted number of cases exceeded 3,000 per year as of April 30, 2022. Focusing on late Phase II data collection is a novel and significantly different approach compared with previous studies. The results of this study are currently under investigation. Conclusions: J-CARRY will provide real-world data regarding the current status and prognosis of CVD in patients who undergo Phase II CR in Japan.
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Affiliation(s)
- Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine
| | - Miho Nishitani-Yokoyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Akiko Ushijima
- Department of Cardiovascular Medicine, Tokai University Hachioji Hospital
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Hospital
| | - Masanobu Miura
- Department of Cardiovascular Medicine, Iwate Prefectural Central Hospital
| | | | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | - Hideo Izawa
- Department of Cardiology, Fujita Health University School of Medicine
| | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine University of the Ryukyus
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine
| | | | | | | | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
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11
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Stiles SL, Roche I, Said M, Clifford RM, Sanfilippo FM, Loh R, Salter SM. Overview of registries for anaphylaxis: a scoping review. JBI Evid Synth 2022; 20:2656-2696. [PMID: 35942638 DOI: 10.11124/jbies-21-00182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This review aimed to describe the scope and operational features of anaphylaxis registries, and to assess their contribution to improving knowledge of anaphylaxis and care of patients who experience anaphylaxis by measuring their research output. INTRODUCTION Structured data collection and reporting systems, such as registries, are needed to better understand the burden of anaphylaxis and to protect the growing number of patients with severe allergy. There is a need to characterize current anaphylaxis registries to identify their value in anaphylaxis surveillance, management, and research. Information synthesized in this review will provide knowledge on benefits and gaps in current registries, which may inform the implementation and global standardization of future anaphylaxis reporting systems. INCLUSION CRITERIA This scoping review considered literature describing registries worldwide that enroll patients who have experienced anaphylaxis. Published and gray literature sources were included if they described the scope and operational features of anaphylaxis registries. METHODS This review followed the JBI methodology for scoping reviews. Embase, MEDLINE, Scopus, and CINAHL were searched for relevant articles. Identified keywords and index terms were adapted for searches of gray literature sources, using Google advanced search functions. Only full-text studies in English were considered for inclusion. Two independent reviewers conducted title and abstract screening and those that did not meet the inclusion criteria were excluded. The full text of potentially relevant articles were retrieved; full-text screening and data extraction were also conducted by two independent reviewers. Any discrepancies were resolved through discussion or with a third reviewer. Tables and a narrative summary were used to describe and compare the scope and features (eg, inclusion criteria, patient demographics, clinical symptoms) of the identified anaphylaxis registries, and to outline their output to assess their contribution to research and clinical practice for anaphylaxis. RESULTS A total of 77 full-text publications and eight gray literature sources were used to extract data. The literature search identified 19 anaphylaxis registries, with sites in 28 countries including Europe, the United Kingdom, Canada, the United States, Korea, and Australia. The main purposes of the identified registries were to collect clinical data for research; provide clinical support tools to improve patient care; and operate as allergen surveillance systems to protect the wider community with allergies. Differences in inclusion and health care settings exist, with 11 collecting data on anaphylaxis of any cause, two on food reactions alone, three on fatal anaphylaxis, one on perioperative anaphylaxis, and two on allergic reactions (including anaphylaxis). Five registries enroll cases in allergy centers, five in hospital settings, one in schools, and others target a combination of general practitioners, specialists in emergency departments, and other relevant hospital departments and allergy outpatient clinics. Only three registries operate under a mandatory framework. A total of 57 publications were considered research outputs from registries. All registries except two have published studies from collected data, with the greatest number of articles published from 2019 to the present. Publications mostly addressed questions regarding demographic profile, causes and cofactors, severity, fatal reactions, and gaps in management. CONCLUSIONS This review demonstrated that anaphylaxis registries differ in their scope and operation, having been established for different purposes. Importantly, registries have contributed significantly to research, which has highlighted gaps in anaphylaxis management, provoking allergens, and informed targets for prevention for severe and fatal events. Beyond this, registries relay information about anaphylaxis to clinicians and regulatory bodies to improve patient care and protect the community. The ability to link registry data with other health datasets, standardization of data across registries, and incorporation of clinical care indicators to promote quality health care across the health system represent important targets for future systems.
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Affiliation(s)
| | | | - Maria Said
- The University of Western Australia, Perth, WA, Australia.,Allergy and Anaphylaxis Australia, Sydney, NSW, Australia.,National Allergy Strategy, Sydney, NSW, Australia
| | | | | | - Richard Loh
- The University of Western Australia, Perth, WA, Australia.,Perth Children's Hospital, Perth, WA, Australia.,Australasian Society of Clinical Immunology and Allergy (ASCIA), Sydney, NSW, Australia
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12
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Oliaei S, Karimi A, Shamsabadi A, Mirzapour P, Mojdeganlou H, Nazeri Z, Bagheri AB, Nazarian N, Jashaninejad R, Qodrati M, Amiri Fard I, Ghanadinezhad F, Afzalian A, Heydari M, Mehraeen E, SeyedAlinaghi S. Design, development, and evaluation of a registry system for hyperbaric oxygen therapy: A methodological study. Health Sci Rep 2022; 5:e768. [PMID: 35949684 PMCID: PMC9358536 DOI: 10.1002/hsr2.768] [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: 02/01/2022] [Revised: 05/19/2022] [Accepted: 06/19/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Aims Hyperbaric oxygen therapy (HBOT), utilizes 100% oxygen at pressures greater than sea-level atmospheric pressure, for the treatment of conditions in which the tissues starve for oxygen. The Undersea and Hyperbaric Medical Society (UHMS) has granted HBOT approval for the treatment of various conditions. On the other hand, applying informatics registry systems can improve care delivery, ameliorate outcomes, and reduce the costs and medical errors for the patients receiving HBOT treatment. Therefore, we aimed to design, develop, and evaluate a registry system for patients undergoing HBOT. Methods In the first phase, the conceptual and logical models were designed after conducting symposiums with experts and having other experts review the models. In the second phase, the system was developed on the web using ASP.NET and C# programming languages frameworks. The last phase involved Nielsen's heuristic evaluation method for the system's usability. Five experts evaluated the system, including three health information management specialists and two medical informatics specialists. Results The hyperbaric patient information registry system (HPIRS) interacts with three types of users-a specialist physician, a nurse, and a system administrator. A scenario for each predefined activity was designed, and all the information was stored in the SQL servers. The five experts independently found 152 issues, of which 84 were duplicates. The 68 distinct issues of the system were then resolved. Conclusions The design and development of such registry systems can make data available and stored carefully to improve clinical care and medical research and decrease costs and errors. These registries can provide the healthcare systems with E-health applications, improved data management, more secure data transfer, and support for statistical reporting. The implemented heuristic evaluation method can also provide a low-cost and readily available system to fix the issues of the designed systems.
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Affiliation(s)
- Shahram Oliaei
- HBOT Research Center, Golestan Hospital, Islamic Republic of IranNavy and AJA Medical UniversityTehranIran
| | - Amirali Karimi
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Ahmadreza Shamsabadi
- Department of Health Information TechnologyEsfarayen Faculty of Medical SciencesEsfarayenIran
| | - Pegah Mirzapour
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk BehaviorsTehran University of Medical SciencesTehranIran
| | | | - Zahra Nazeri
- Department of Health Information ManagementTehran University of Medical SciencesTehranIran
| | - Amir B. Bagheri
- Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Interdisciplinary Consortium on Advanced Motion PerformanceBaylor College of MedicineHoustonTexasUSA
- Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | | | - Reyhaneh Jashaninejad
- Department of Epidemiology, School of Public HealthHamadan University of Medical SciencesHamadanIran
| | - Mohammad Qodrati
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk BehaviorsTehran University of Medical SciencesTehranIran
| | - Iman Amiri Fard
- Department of Community Health Nursing and Geriatric Nursing, School of Nursing and MidwiferyIran University of Medical SciencesTehranIran
| | | | - Arian Afzalian
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Mohammad Heydari
- Department of Health Information TechnologyKhalkhal University of Medical SciencesKhalkhalIran
| | - Esmaeil Mehraeen
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk BehaviorsTehran University of Medical SciencesTehranIran
- Department of Health Information TechnologyKhalkhal University of Medical SciencesKhalkhalIran
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk BehaviorsTehran University of Medical SciencesTehranIran
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13
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Abukhadijah HJ, Turk-Adawi KI, Dewart N, Grace SL. Qualitative study measuring the usability of the International Cardiac Rehabilitation Registry. BMJ Open 2022; 12:e064255. [PMID: 36038174 PMCID: PMC9438019 DOI: 10.1136/bmjopen-2022-064255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Cardiac rehabilitation (CR) is a comprehensive model of secondary preventive care. There is a wide variety in implementation characteristics globally, and hence quality control is paramount. Thus, the International Council of Cardiovascular Prevention and Rehabilitation was urged to develop a CR registry. The purpose of this study was to test the perceived usability of the International Cardiac Rehabilitation Registry (ICRR) to optimise it. DESIGN This was a qualitative study, comprising virtual usability tests using a think-aloud method to elicit feedback on the ICRR, while end-users were entering patient data, followed by semistructured interviews. SETTING Ultimately, 12 tests were conducted with CR staff (67% female) in low-resource settings from a variety of disciplines in all regions of the world but Europe before saturation was achieved. PRIMARY OUTCOME MEASURE Participants completed the System Usability Scale. Interviews were transcribed verbatim except to preserve anonymity, and coded using NVIVO by two researchers independently. The Unified Theory of Acceptance and Use of Technology 2 informed analysis. RESULTS The ICRR was established as easy to use, relevant, efficient, with easy learnability, operability, perceived usefulness, positive perceptions of output quality and high end-user satisfaction. System usability was 83.75, or 'excellent' and rated 'A'. Four major themes were deduced from the interviews: (1) ease of approvals, adoption and implementation; (2) benefits for programmes, (3) variables and their definitions, as well as (4) patient report and follow-up assessment. Based on participant observation and utterances, suggestions for changes to the ICRR were implemented, including to the programme survey, on-boarding processes, navigational instructions, inclusion of programme logos, direction on handling unavailable data and optimising data completeness, as well as policies for authorship and programme certification. CONCLUSIONS With usability of the ICRR optimised, pilot testing shall ensue.
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Affiliation(s)
- Hana J Abukhadijah
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Karam I Turk-Adawi
- Department of Public Health,College of Health Sciences,QU Health, Qatar University, Doha, Qatar
| | - Nora Dewart
- Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Sherry L Grace
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
- KITE Research Institute-Toronto Rehabilitation Institute & Peter Munk Cardiac Centre, University Health Network,University of Toronto, Toronto, Ontario, Canada
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14
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Mone P, Izzo R, Marazzi G, Manzi MV, Gallo P, Campolongo G, Cacciotti L, Tartaglia D, Caminiti G, Varzideh F, Santulli G, Trimarco V. L-Arginine Enhances the Effects of Cardiac Rehabilitation on Physical Performance: New Insights for Managing Cardiovascular Patients During the COVID-19 Pandemic. J Pharmacol Exp Ther 2022; 381:197-203. [PMID: 35339987 DOI: 10.1124/jpet.122.001149] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/21/2022] [Indexed: 11/22/2022] Open
Abstract
Cardiac rehabilitation (CR) following acute myocardial infarction (AMI) improves physical capacities and decreases hospitalizations and cardiovascular mortality. L-Arginine is the substrate used by nitric oxide (NO) synthase (NOS) to generate NO and it has been shown to exert its beneficial effects on endothelium driving vasodilatation, reducing inflammation, and ameliorating physical function. We hypothesized that L-Arginine could enhance physical capacities in patients who underwent CR after AMI. We designed a study aimed to assess the effects of L-arginine administration on the physical capacity of patients who underwent coronary revascularization after AMI. The trial was carried out amid the COVID-19 pandemic. Patients were assigned, with a 2:1 ratio, to add to their standard therapy 1 bottle containing 1.66 g of L-arginine or 1 bottle of identical aspect apart from not containing L-arginine, twice a day orally for 3 weeks. Patients performed a 6-minute walking test (6MWT) and were assessed their Borg modified 0-10 rating of perceived exertion (BRPE) before starting and at the end of the treatment. Seventy-five patients receiving L-Arginine, and thirty-five receiving placebo successfully completed the study. The 6MWT distance increased significantly in the L-Arginine group compared to both baseline and placebo (p<0.0001). Additionally, we observed a significant improvement in the BRPE in patients treated with L-arginine but not in the placebo group. Taken together, our data indicate that L-arginine potentiates the response to CR, independently of age, sex, baseline functional capacity, and comorbid conditions. Significance Statement This study shows for the first time that oral supplementation of L-arginine potentiates the response to cardiac rehabilitation after myocardial infarction and cardiac revascularization. Indeed, we observed a significant improvement in two fundamental parameters, namely, the 6-minute walking test and the Borg modified 0-10 rating of perceived exertion. Strikingly, the beneficial effects of L-arginine were independent from age, sex, comorbid conditions, and baseline functional capacity.
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15
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Development of the International Cardiac Rehabilitation Registry Including Variable Selection and Definition Process. Glob Heart 2022; 17:1. [PMID: 35174042 PMCID: PMC8757385 DOI: 10.5334/gh.1091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/15/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: The International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) is developing a registry (ICRR) specifically for low-resource settings, where the burden of cardiovascular diseases is greatest and the need for program development highest. Herein we describe the development process, including the variable selection process. Method: Following a literature search on registry best practices, a stepwise model for ICRR development was identified. Then, based on recommendations by Core Outcome Set-STAndards for Development (COS-STAD), we underwent a process to identify variables. All available CR registries were contacted to request their data dictionaries, reviewed CR quality indicators and guideline recommendations, and searched for common data elements and core outcome sets; 35 unique variables (including patient-reported outcomes) were selected for potential inclusion. Twenty-one purposively-identified stakeholders and experts agreed to serve on a Delphi panel. Panelists rated the variables in an online survey, and suggested potential additional variables; A webcall was held to reach consensus on which to include/exclude. Next, panelists provided input to finalize each variable definition, and rated which associated indicators should be used for benchmarking in registry dashboards and a patient lay summary; a second consensus call was held. A 1-month public comment period ensued. Results: First, registry objectives and governance were approved by ICCPR, including data quality and access policies. The protocol was developed, for public posting. For variable selection, the overall mean rating was 6.1 ± 0.3/7; 12 were excluded, some of which were moved to a program survey, and others were revised. Two variables were added in an annual follow-up, resulting in 13 program and 16 patient-reported variables. Legal advice was sought to finalize ICRR agreements. Ethics approvals were obtained. Usability testing is now being initiated. Conclusion: It is hoped this will serve to harmonize CR assessment internationally and enable quality improvement in CR delivery in low-resource settings.
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16
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O'Connell ME, Suskin N, Prior PL. Measuring True Change in Individual Patients: Reliable Change Indices of Cardiac Rehabilitation Outcomes, and Implications for Quality Indicators. CJC Open 2021; 3:1139-1148. [PMID: 34712940 PMCID: PMC8531211 DOI: 10.1016/j.cjco.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mediated by outcomes such as improved exercise capacity, cardiac rehabilitation (CR) reduces morbidity and mortality. For accuracy, an individual CR patient's change must be measured reliably, an issue not typically considered in practice. Drawing from psychometric theory, we calculated reliable change indices (RCIs), to measure individual CR patients' true clinical change, apart from that from error and test practice/exposure, in exercise capacity, anxiety, and depression. METHODS Indirectly calculated exercise capacity (peak metabolic equivalents [METs]) and psychological symptoms were each measured twice, 1 week apart, by administering treadmill tests or the Hospital Anxiety and Depression Scale (HADS) to separate samples of 35 (mean age: 59.0 years; 6 women) and 96 (mean age: 64.4 years; 32 women) CR patients, respectively. Using test-retest reliability and mean difference scores from these samples to estimate error and practice/exposure effects, we calculated RCIs for a separate cohort (n = 2066; mean age: 62.0 years; 533 women) who completed 6-month CR, and compared change distributions (worsened/unchanged/improved) based on critical RCIs, mean and percent changes, cut-off scores, and standard deviations. RESULTS Practice/exposure effects were nonsignificant, except the mean HADS anxiety score decreased significantly (P ≤ 0.013; d = 0.17, small effect). Test-retest reliabilities were high (METs r = 0.934; HADS anxiety score r = 0.912; HADS depression score r = 0.90; P < 0.001). Among 2066 CR patients, RCI distributions differed (P < 0.001) from those of most other change criteria. CONCLUSIONS Change ascertainment depends on criterion choice. A Canadian Cardiovascular Society CR quality indicator of increase by 0.5 MET may be too small to assess individuals' functional capacity change. RCIs offer a pragmatic approach to benchmarking reliable change frequency, and pending further validation, could be used for feedback to individual patients.
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Affiliation(s)
- Megan E. O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Neville Suskin
- St Joseph's Hospital Cardiac Rehabilitation & Secondary Prevention Program, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Peter L. Prior
- St Joseph's Hospital Cardiac Rehabilitation & Secondary Prevention Program, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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17
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Magán I, Casado L, Jurado-Barba R, Barnum H, Redondo MM, Hernandez AV, Bueno H. Efficacy of psychological interventions on psychological outcomes in coronary artery disease: systematic review and meta-analysis. Psychol Med 2021; 51:1846-1860. [PMID: 32249725 DOI: 10.1017/s0033291720000598] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The benefits of cognitive-behavioral treatment (CBT) and positive psychology therapy (PPT) in patients with cardiovascular disease are still not well defined. We assessed the efficacy of CBT and PPT on psychological outcomes in coronary artery disease (CAD) patients. METHODS Randomized controlled trials evaluating CBT or PPT in CAD patients published until May 2018 were systematically analyzed. Primary outcomes were depression, stress, anxiety, anger, happiness, and vital satisfaction. Random effects meta-analyses using the inverse variance method were performed. Effects were expressed as standardized mean difference (SMD) or mean differences (MD) with their 95% confidence intervals (CIs); risk of bias was assessed with the Cochrane tool. RESULTS Nineteen trials were included (n = 1956); sixteen evaluated CBT (n = 1732), and three PPT (n = 224). Compared with control groups, depressive symptoms (13 trials; SMD -0.80; 95% CI -1.33 to -0.26), and anxiety (11 trials; SMD -1.26; 95% CI -2.11 to -0.41) improved after the PI, and depression (6 trials; SMD -2.08; 95% CI -3.22 to -0.94), anxiety (5 trials; SMD -1.33; 95% CI -2.38 to -0.29), and stress (3 trials; SMD -3.72; 95% CI -5.91 to -1.52) improved at the end of follow-up. Vital satisfaction was significantly increased at follow-up (MD 1.30, 0.27, 2.33). Non-significant effects on secondary outcomes were found. Subgroup analyses were consistent with overall analyses. CONCLUSION CBT and PPT improve several psychological outcomes in CAD patients. Depression and anxiety improved immediately after the intervention while stress and vital satisfaction improve in the mid-term. Future research should assess the individual role of CBT and PPT in CAD populations.
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Affiliation(s)
- Inés Magán
- Department of Psychology, Facultad de Educación y Salud, Universidad Camilo José Cela, Madrid, Spain
| | - Laura Casado
- Department of Psychology, Facultad de Educación y Salud, Universidad Camilo José Cela, Madrid, Spain
| | - Rosa Jurado-Barba
- Department of Psychology, Facultad de Educación y Salud, Universidad Camilo José Cela, Madrid, Spain
- Instituto de Investigación Biomédica del Hospital 12 de Octubre (Imas12), Madrid, Spain
| | - Haley Barnum
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Marta M Redondo
- Department of Psychology, Facultad de Educación y Salud, Universidad Camilo José Cela, Madrid, Spain
| | - Adrian V Hernandez
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
- Vicerrectorado de Investigacion, Universidad San Ignacio de Loyola (USIL), Lima, Peru
| | - Héctor Bueno
- Instituto de Investigación Biomédica del Hospital 12 de Octubre (Imas12), Madrid, Spain
- Department of Cardiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Multidisciplinary Translational Cardiovascular Research Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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18
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Abstract
PURPOSE OF REVIEW Cardiac rehabilitation (CR) is grossly under-utilized. This review summarizes current knowledge about degree of CR utilization, reasons for under-utilization, and strategies to increase use. RECENT FINDINGS ICCPR's global CR audit quantified for the first time the number of additional CR spots needed per year to treat indicated patients, so there are programs they may use. The first randomized trial of automatic/systematic CR referral has shown it results in significantly greater patient completion. Moreover, the recent update of the Cochrane review on interventions to increase use has provided unequivocal evidence on the significant impact of clinician CR encouragement at the bedside; a course is now available to train clinicians. The USA is leading the way in implementing automatic referral with inpatient-clinician CR discussions. Suggestions to triage patients based on risk to less resource-intensive, unsupervised program models could simultaneously expand capacity and support patient adherence.
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Affiliation(s)
- Sherry L Grace
- Faculty of Health, York University, 4700 Keele Street, Toronto, Canada. .,KITE-Toronto Rehabilitation Institute, Toronto, ON, Canada. .,Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,Imperial College Healthcare NHS Trust, London, UK
| | - Mary A Whooley
- US Department of Veterans Affairs Quality Enhancement Research Initiative, San Francisco, USA.,University of California, San Francisco, USA
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19
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Nishitani-Yokoyama M, Daida H, Shimada K, Ushijima A, Kida K, Kono Y, Sakata Y, Nagayama M, Furukawa Y, Fukuma N, Saku K, Miura SI, Ohya Y, Goto Y, Makita S. Effects of Phase II Comprehensive Cardiac Rehabilitation on Risk Factor Modification and Exercise Capacity in Patients With Acute Coronary Syndrome ― Results From the JACR Registry ―. Circ Rep 2020; 2:715-721. [PMID: 33693201 PMCID: PMC7937521 DOI: 10.1253/circrep.cr-20-0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background:
Cardiac rehabilitation (CR) is categorized as a Class I recommendation in guidelines for the management of patients with acute coronary syndrome (ACS); however, nationwide studies on CR in patients with ACS remain limited in Japan. Methods and Results:
The Japanese Association of Cardiac Rehabilitation (JACR) Registry is a nationwide, real-world database for patients participating in CR. From the JACR Registry database, we analyzed 924 patients participating in Phase II CR in 7 hospitals between September 2014 and December 2016. The mean age of patients was 65.9±12.0 years, and 80% were male. The prevalence of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina pectoris (UAP) was 58%, 9%, and 33%, respectively. The prevalence of hypertension, diabetes, dyslipidemia, current smoking, and a family history was 55%, 27%, 67%, 21%, and 10%, respectively. Among the entire CR cohort at baseline, 96%, 78%, and 92% were treated with aspirin, β-blockers, and statins, respectively. After CR, the values of body mass index, the lipid profile, and exercise capacity significantly improved in the STEMI, NSTEMI and UAP groups. Conclusions:
In the JACR Registry, a high rate of guideline-recommended medications at baseline and improvements in both coronary risk factors and exercise capacity after CR were observed in patients with ACS.
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Affiliation(s)
- Miho Nishitani-Yokoyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
- Faculty of Health and Science Juntendo University
| | - Kazunori Shimada
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Akiko Ushijima
- Department of Cardiovascular Medicine, Tokai University Hachioji Hospital
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Hospital
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University School of Medicine
| | | | - Yutaka Furukawa
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Nagaharu Fukuma
- School of Nursing, Japanese Red Cross Toyota College of Nursing
| | - Keijiro Saku
- Department of Cardiovascular Medicine, Fukuoka University School of Medicine
| | - Shin-ichiro Miura
- Department of Cardiovascular Medicine, Fukuoka University School of Medicine
| | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine University of the Ryukyus
| | | | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
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20
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Abstract
PURPOSE Despite evidence of the effectiveness of cardiac rehabilitation (CR), there is wide variability in programs, which may impact their quality. The objectives of this review were to (1) evaluate the ways in which we measure CR quality internationally; (2) summarize what we know about CR quality and quality improvement; and (3) recommend potential ways to improve quality. METHODS For this narrative review, the literature was searched for CR quality indicators (QIs) available internationally and experts were also consulted. For the second objective, literature on CR quality was reviewed and data on available QIs were obtained from the Canadian Cardiac Rehabilitation Registry (CCRR). For the last objective, literature on health care quality improvement strategies that might apply in CR settings was reviewed. RESULTS CR QIs have been developed by American, Canadian, European, Australian, and Japanese CR associations. CR quality has only been audited across the United Kingdom, the Netherlands, and Canada. Twenty-seven QIs are assessed in the CCRR. CR quality was high for the following indicators: promoting physical activity post-program, assessing blood pressure, and communicating with primary care. Areas of low quality included provision of stress management, smoking cessation, incorporating the recommended elements in discharge summaries, and assessment of blood glucose. Recommended approaches to improve quality include patient and provider education, reminder systems, organizational change, and advocacy for improved CR reimbursement. An audit and feedback strategy alone is not successful. CONCLUSIONS Although not a lot is known about CR quality, gaps were identified. The quality improvement initiatives recommended herein require testing to ascertain whether quality can be improved.
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Thomas E, Grace SL, Boyle D, Gallagher R, Neubeck L, Cox N, Manski-Nankervis JA, Henley-Smith S, Cadilhac DA, O’Neil A. Utilising a Data Capture Tool to Populate a Cardiac Rehabilitation Registry: A Feasibility Study. Heart Lung Circ 2020; 29:224-232. [DOI: 10.1016/j.hlc.2018.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/26/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
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Reich B, Benzer W, Harpf H, Hofmann P, Mayr K, Ocenasek H, Podolsky A, Pokan R, Porodko M, Puelacher C, Sareban M, Traninger H, Ziegelmeyer W, Niebauer J. Efficacy of extended, comprehensive outpatient cardiac rehabilitation on cardiovascular risk factors: A nationwide registry. Eur J Prev Cardiol 2020; 27:1026-1033. [DOI: 10.1177/2047487319898958] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aim Cardiac rehabilitation (CR) is a key component of the treatment of cardiac diseases. The Austrian outpatient CR model is unique, as it provides patients with an extended professionally supervised, multidisciplinary program of 4–6 weeks of phase II (OUT-II) and 6–12 months of phase III (OUT-III) CR. The aim of this analysis was to assess the efficacy of the Austrian outpatient CR model using a nationwide registry. Methods Data of all consecutive patients ( N = 7560) who completed OUT-II and/or OUT-III between 1 January 2005 and 31 December 2015 were entered prospectively into a registry. OUT-III patients were analyzed separately according to whether the preceding phase II was performed as outpatient (OUT-II/OUT-III, N = 2403) or in-patient (IN-II/OUT-III, N = 2789). All patients underwent assessment of anthropometry, resting blood pressure, lipid profile, fasting blood glucose, exercise capacity, quality of life, anxiety and depression. Results During OUT-II, patients significantly improved their metabolic risk factor profile and increased exercise capacity by 14.3%. OUT-II/OUT-III patients achieved an additional increase in exercise capacity by 10%, further improvement in high-density lipoprotein (HDL) and stabilization of the remaining risk factors. IN-II/OUT-III patients increased their maximal exercise capacity by 18.4% and there was improvement in blood pressure, HDL, low-density lipoprotein and glucose levels. Conclusion Extended, professionally supervised, multidisciplinary outpatient CR in a large nationwide registry of consecutive patients consistently improved maximal exercise capacity and relevant modifiable cardiovascular risk factors beyond effects seen after IN- or OUT-II alone.
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Affiliation(s)
- Bernhard Reich
- Institute of Sports Medicine, Prevention and Rehabilitation Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Werner Benzer
- Out-Patient Cardiac Rehabilitation Centre, Feldkirch, Austria
| | - Hanns Harpf
- Out-Patient Cardiac Rehabilitation Center, Graz, Austria
| | - Peter Hofmann
- Exercise Physiology, Training and Training Therapy Research Group, Institute of Sports Science, University of Graz, Graz, Austria
| | - Karl Mayr
- CARDIOMED Cardiac Rehabilitation Center, Linz, Austria
| | | | - Andrea Podolsky
- Institute of Preventive and Applied Sports Medicine, University Hospital Krems, Krems, Austria
| | - Rochus Pokan
- Institute of Sport Science, Center for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Michael Porodko
- Institute of Preventive and Rehabilitative Medicine, CardioVitals Wels, Wels, Austria
| | - Christoph Puelacher
- Institute of Out-Patient Cardiac and Pulmonary Rehabilitation, REHAmed-Tirol, Innsbruck, Austria
| | - Mahdi Sareban
- Institute of Sports Medicine, Prevention and Rehabilitation Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | | | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
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Barradas-Pires A. Cardiac rehabilitation programmes: Cost-effective and a potential instrument against health inequalities. Eur J Prev Cardiol 2019; 27:1101-1103. [DOI: 10.1177/2047487319887829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ana Barradas-Pires
- Department of Cardiology and ACHD, Royal Brompton and Harefield Hospital NHS Trust, UK
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Thomas E, Astley C, Gallagher R, Foreman R, Mitchell JA, Grace SL, Cadilhac DA, Bunker S, Clark A, O'Neil A. Improving the Monitoring of Cardiac Rehabilitation Delivery and Quality: A Call to Action for Australia. Heart Lung Circ 2019; 29:1-4. [PMID: 31466852 DOI: 10.1016/j.hlc.2019.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/08/2019] [Accepted: 07/31/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Emma Thomas
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia; National Heart Foundation of Australia, Brisbane, Qld, Australia.
| | - Carolyn Astley
- South Australian Academic Health Science and Translation Centre, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Rachelle Foreman
- National Heart Foundation of Australia, Brisbane, Qld, Australia
| | | | - Sherry L Grace
- Faculty of Health, York University & University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dominique A Cadilhac
- Translational Public Health and Evaluation Division, Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic, Australia; Public Health: Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Vic, Australia
| | - Stephen Bunker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Alexander Clark
- National Heart Foundation of Australia, Melbourne, Vic, Australia
| | - Adrienne O'Neil
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia; Heart & Mind Research, School of Medicine, Deakin University, Melbourne, Vic, Australia
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Supervia M, Turk-Adawi K, Lopez-Jimenez F, Pesah E, Ding R, Britto RR, Bjarnason-Wehrens B, Derman W, Abreu A, Babu AS, Santos CA, Jong SK, Cuenza L, Yeo TJ, Scantlebury D, Andersen K, Gonzalez G, Giga V, Vulic D, Vataman E, Cliff J, Kouidi E, Yagci I, Kim C, Benaim B, Estany ER, Fernandez R, Radi B, Gaita D, Simon A, Chen SY, Roxburgh B, Martin JC, Maskhulia L, Burdiat G, Salmon R, Lomelí H, Sadeghi M, Sovova E, Hautala A, Tamuleviciute-Prasciene E, Ambrosetti M, Neubeck L, Asher E, Kemps H, Eysymontt Z, Farsky S, Hayward J, Prescott E, Dawkes S, Santibanez C, Zeballos C, Pavy B, Kiessling A, Sarrafzadegan N, Baer C, Thomas R, Hu D, Grace SL. Nature of Cardiac Rehabilitation Around the Globe. EClinicalMedicine 2019; 13:46-56. [PMID: 31517262 PMCID: PMC6733999 DOI: 10.1016/j.eclinm.2019.06.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a clinically-effective but complex model of care. The purpose of this study was to characterize the nature of CR programs around the world, in relation to guideline recommendations, and compare this by World Health Organization (WHO) region. METHODS In this cross-sectional study, a piloted survey was administered online to CR programs globally. Cardiac associations and local champions facilitated program identification. Quality (benchmark of ≥ 75% of programs in a given country meeting each of 20 indicators) was ranked. Results were compared by WHO region using generalized linear mixed models. FINDINGS 111/203 (54.7%) countries in the world offer CR; data were collected in 93 (83.8%; N = 1082 surveys, 32.1% program response rate). The most commonly-accepted indications were: myocardial infarction (n = 832, 97.4%), percutaneous coronary intervention (n = 820, 96.1%; 0.10), and coronary artery bypass surgery (n = 817, 95.8%). Most programs were led by physicians (n = 680; 69.1%). The most common CR providers (mean = 5.9 ± 2.8/program) were: nurses (n = 816, 88.1%; low in Africa, p < 0.001), dietitians (n = 739, 80.2%), and physiotherapists (n = 733, 79.3%). The most commonly-offered core components (mean = 8.7 ± 1.9 program) were: initial assessment (n = 939, 98.8%; most commonly for hypertension, tobacco, and physical inactivity), risk factor management (n = 928, 98.2%), patient education (n = 895, 96.9%), and exercise (n = 898, 94.3%; lower in Western Pacific, p < 0.01). All regions met ≥ 16/20 quality indicators, but quality was < 75% for tobacco cessation and return-to-work counseling (lower in Americas, p = < 0.05). INTERPRETATION This first-ever survey of CR around the globe suggests CR quality is high. However, there is significant regional variation, which could impact patient outcomes.
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Affiliation(s)
- Marta Supervia
- Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Dr. Esquerdo, 46, 28007 Madrid, Spain
- Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | | | | | - Ella Pesah
- York University, 4700 Keele Street, Toronto, Ontario M3J1P3, Canada
| | - Rongjing Ding
- Peiking University People' Hospital, 11 Xizhimen S St, Xicheng Qu, Beijing Shi, China
| | - Raquel R. Britto
- Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG 31270-901, Brazil
| | - Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, Dep. Preventive and Rehabilitative Sport Medicine and Exercise Physiology, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Wayne Derman
- Stellenbosch University & International Olympic Committee Research Center South Africa, Francie Van Zijl Drive, Stellenbosch 7599, South Africa
| | - Ana Abreu
- Hospital Santa Marta, R. de Santa Marta 50, Lisbon 1169-024, Portugal
| | - Abraham S. Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal - 576104, Karnataka
| | | | - Seng K. Jong
- Hospital Raja Isteri Pengiran Anak Saleha, Bandar Seri Begawan BA1710, Brunei
| | - Lucky Cuenza
- Philippine Heart Center, East Avenue, Quezon City 1100, Philippines
| | - Tee Joo Yeo
- National University Heart Centre Singapore, National University Health System Tower Block, 1E Kent Ridge Road, Level 9, Cardiac Department, Singapore 119228, Singapore
| | - Dawn Scantlebury
- University of the West Indies at Cave Hill, St. Michael, Barbados
| | - Karl Andersen
- University of Iceland, Saemundargata 2, IS-101 Reykjavik, Iceland
| | | | - Vojislav Giga
- Institute of Cardiovascular Diseases, Clinical Center of Serbia, Dr. Koste Todorovića 8, 11000 Beograd, Serbia
| | - Dusko Vulic
- University of Banja Luka, Faculty of Medicine, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina
| | - Eleonora Vataman
- Institute of Cardiology, Str. Testemitanu, 20, Chisinau, Republic of Moldova
| | - Jacqueline Cliff
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, Wales, United Kingdom
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki 57001, Greece
| | - Ilker Yagci
- Marmara University, School of Medicine, Department of Physical Medicine and Rehabilitation, Fevzi Çakmak Mah Muhsin Yazıcıoğlu Cad. No:10 Üst Kaynarca Pendik / İstanbul, Turkey
| | - Chul Kim
- Sanggye Paik Hospital, Inje University, Dongil-ro 1342, Nowon-gu, Seoul, Republic of Korea
| | - Briseida Benaim
- Asociacion Cardiovascular Centroccidental (ASCARDIO), 17 Callejón 12, Barquisimeto 3001, Lara, Venezuela
| | - Eduardo Rivas Estany
- ICCCV Instituto de Cardiología y Cirugía Cardiovascular, No. 702 entre A y Paseo, Vedado, Calle 17, La Habana, Cuba
| | - Rosalia Fernandez
- Instituto Nacional Cardiovascular (INCOR), Jirón Coronel Zegarra, Jesus Maria, Lima 11, Peru
| | - Basuni Radi
- National Cardiovascular Center Harapan Kita, Kav 87, Jl. Letjen. S. Parman, Jakarta, Indonesia
| | - Dan Gaita
- University of Medicine & Pharmacy “Victor Babes”, Cardiovascular Prevention & Rehabilitation Clinic, Bvd CD Loga 49, 300020 Timisoara, Romania
| | - Attila Simon
- State Hospital for Cardiology, Gyógy tér 2, Balatonfüred 8230, Hungary
| | - Ssu-Yuan Chen
- Fu Jen Catholic University Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City 24352, Taiwan
| | - Brendon Roxburgh
- The University of Auckland, 71 Merton Road, Private Bag 92019, Auckland 1142, New Zealand
| | | | - Lela Maskhulia
- Tbilisi State Medical University, 33 Vazha Pshavela Ave, Tbilisi, Georgia
| | - Gerard Burdiat
- Spanish Association Hospital, Bulevar Gral. Artigas 1471, Montevideo 1471, Uruguay
| | - Richard Salmon
- PHYSIS Prevencion Cardiovascular, Cdla Bolivariana Av. del Libertador - Mz I Villa 5, Guayaquil, Ecuador
| | - Hermes Lomelí
- Instituto Nacional de Cardiología, Belisario Domínguez Sección 16, Tlalpan, 14080 CDMX, Mexico
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Hezar-Jerib Ave., Isfahan 81746 73461, IR, Iran
| | - Eliska Sovova
- University of Palacky, University Hospital Olomouc, I.P. Pavlova 185/6, Nová Ulice, 779 00 Olomouc, Czech Republic
| | - Arto Hautala
- Cardiovascular Research Group, Division of Cardiology, Oulu University Hospital, University of Oulu, Finland
| | | | - Marco Ambrosetti
- Istituti Clinici Scientifici Maugeri, Care and Research Institute, Department of Cardiac Rehabilitation, Pavia, Italy
| | - Lis Neubeck
- Edinburgh Napier University, 9 Sighthill Ct, Edinburgh EH11 4BN, Scotland, United Kingdom
| | - Elad Asher
- Shaare Zedek Medical Center, the Hebrew University, Jerusalem, Israel
| | - Hareld Kemps
- Maxima Medical Centre, De Run 4600, 5504 DB Veldhoven, Netherlands
| | - Zbigniew Eysymontt
- Ślaskie Centrum Rehabilitacji w Ustroniu, Zdrojowa 6, 43-450 Ustroń, Poland
| | - Stefan Farsky
- Heart House Martin, Bagarova 30, Martin, Podháj, Slovakia
| | - Jo Hayward
- Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Eva Prescott
- Bispebjerg Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 København, NV, Denmark
| | - Susan Dawkes
- Edinburgh Napier University, 9 Sighthill Ct, Edinburgh EH11 4BN, Scotland, United Kingdom
| | - Claudio Santibanez
- Sociedad Chilena de Cardiología, Alfredo Barros Errázuriz 1954, Providencia, Región Metropolitana, Chile
| | - Cecilia Zeballos
- Cardiovascular Institute of Buenos Aires, Av. del Libertador 6302, 1428 Buenos Aires, Argentina
| | - Bruno Pavy
- Loire-Vendée-Océan Hospital, Boulevard des Régents, 44270 Machecoul, France
| | - Anna Kiessling
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, 182 88 Stockholm, Sweden
| | - Nizal Sarrafzadegan
- University of British Columbia, 2206 East Mall, Vancouver, British Colombia V6T 1Z3, Canada
| | - Carolyn Baer
- Moncton Hospital, 135 Macbeath Ave, Moncton, New Brunswick E1C 6Z8, Canada
| | - Randal Thomas
- Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Dayi Hu
- Beijing United Family Hospital, 2 Jiangtai Rd, Chaoyang Qu, Beijing Shi 100096, China
| | - Sherry L. Grace
- York University, 4700 Keele Street, Toronto, Ontario M3J1P3, Canada
- University Health Network, 399 Bathurst St, Toronto, ON M5T 2S8, Canada
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Lindström Egholm C, Helmark C, Christensen J, Eldh AC, Winblad U, Bunkenborg G, Zwisler AD, Nilsen P. Facilitators for using data from a quality registry in local quality improvement work: a cross-sectional survey of the Danish Cardiac Rehabilitation Database. BMJ Open 2019; 9:e028291. [PMID: 31196902 PMCID: PMC6576126 DOI: 10.1136/bmjopen-2018-028291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To investigate use of data from a clinical quality registry for cardiac rehabilitation in Denmark, considering the extent to which data are used for local quality improvement and what facilitates the use of these data, with a particular focus on whether there are differences between frontline staff and managers. DESIGN Cross-sectional nationwide survey study. SETTING, METHODS AND PARTICIPANTS A previously validated, Swedish questionnaire regarding use of data from clinical quality registries was translated and emailed to frontline staff, mid-level managers and heads of departments (n=175) in all 30 hospital departments participating in the Danish Cardiac Rehabilitation Database. Data were analysed descriptively and through multiple linear regression. RESULTS Survey response rate was 58% (101/175). Reports of registry use at department level (measured through an index comprising seven items; score min 0, max 7, where a low score indicates less use of data) varied significantly between groups of respondents: frontline staff mean score 1.3 (SD=2.0), mid-level management mean 2.4 (SD=2.3) and heads of departments mean 3.0 (SD=2.5), p=0.006. Overall, department level use of data was positively associated with higher perceived data quality and usefulness (regression coefficient=0.22, p=0.019), management request for data (regression coefficient=0.40, p=0.008) and personal motivation of the respondent (regression coefficient=1.63, p<0.001). Among managers, use of registry data was associated with data quality and usefulness (regression coefficient=0.43, p=0.027), and among frontline staff, reported data use was associated with management involvement in quality improvement work (regression coefficient=0.90, p=0.017) and personal motivation (regression coefficient=1.66, p<0.001). CONCLUSIONS The findings suggest relatively sparse use of data in local quality improvement work. A complex interplay of factors seem to be associated with data use with varying aspects being of importance for frontline staff and managers.
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Affiliation(s)
- Cecilie Lindström Egholm
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and the Region of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbaek University Hospital, Holbaek, Denmark
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Roskilde, Denmark
| | - Jan Christensen
- Department of Occupational and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ann Catrine Eldh
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gitte Bunkenborg
- Department of Anesthesiology, Holbaek University Hospital, Holbaek, Denmark
| | - Ann-Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and the Region of Southern Denmark, Odense, Denmark
| | - Per Nilsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Piepoli MF. Editor's presentation. Eur J Prev Cardiol 2019; 26:787-789. [DOI: 10.1177/2047487319848194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, G da Saliceto Hospital, Italy
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Italy
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28
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Piepoli MF. Editor’s presentation. Eur J Prev Cardiol 2019; 26:451-453. [DOI: 10.1177/2047487319837818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza, Italy
- Institute of Life Sciences, Scuola Superiore Sant’Anna, Sant’Anna School of Advanced Studies, Pisa, Italy
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29
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Piepoli MF. Editor’s presentation. Eur J Prev Cardiol 2019; 26:339-341. [DOI: 10.1177/2047487319833263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, Cardiology, G da Saliceto Hospital; Institute of Life Sciences, Sant’Anna School of Advanced Studies, Pisa, Piacenza, Italy
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30
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Andersen UO. Do the rehabilitation centres work according to guidelines? Eur J Prev Cardiol 2019; 26:409-410. [DOI: 10.1177/2047487318819537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Scalvini S, Grossetti F, Paganoni AM, Teresa La Rovere M, Pedretti RFE, Frigerio M. Impact of in-hospital cardiac rehabilitation on mortality and readmissions in heart failure: A population study in Lombardy, Italy, from 2005 to 2012. Eur J Prev Cardiol 2019; 26:808-817. [DOI: 10.1177/2047487319833512] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aims The 2016 European guidelines for the diagnosis and treatment of heart failure classified cardiac rehabilitation as a mandatory class I intervention. We aimed to analyse in heart failure patients the impact of an in-hospital cardiac rehabilitation programme on all-cause mortality and readmissions. Methods From the Lombardy healthcare administrative database, we analysed in patients with incident heart failure, from 2005 to 2012, the number of all hospitalisations, cardiac rehabilitation admissions, post-discharge deaths, outpatient drug prescriptions and visits. We divided patients into hospitalised for heart failure in acute care only (group A) versus patients with one or more admission to cardiac rehabilitation for an in-hospital cardiac rehabilitation programme (group B). Results Of 140,552 incident cases, 100,843 (71%) were in group A and 39,709 (29%) in group B. Patients in group B had 3.26 ± 1.78 admissions to acute care before referral to an in-hospital cardiac rehabilitation programme. Male gender, age in women and comorbidities (more than two) were higher in group B ( P < 0.0001). Patients in group B had a higher number of interventional procedures ( P < 0.0001), drug prescription and outpatient visit rate ( P < 0.0001). Total mortality was 30% in group A versus 29% in group B. At Cox and logistic regression analyses, after adjustment for covariates, group B had a significantly lower risk of mortality (hazard ratio 0.5768, 95% confidence interval 0.5650–0.5888, P < 0.0001) and readmissions (0.7997, 0.7758–0.8244, P < 0.0001) than group A. Conclusion This study showed in a large population of heart failure patients that in-hospital cardiac rehabilitation is associated with a reduction of all-cause mortality and rehospitalisations in heart failure. Given its potential significant benefit, referral of heart failure patients to an in-hospital cardiac rehabilitation programme should be promoted.
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Affiliation(s)
- Simonetta Scalvini
- Cardiology Rehabilitation Department of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Lumezzane, Italy
| | | | | | - Maria Teresa La Rovere
- Cardiology Rehabilitation Department of the Institute of Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Montescano, Italy
| | - Roberto FE Pedretti
- Cardiology Rehabilitation Department of the Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Maria Frigerio
- De Gasperis Cardiocenter, Niguarda-Ca'Granda Hospital, Milan, Italy
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32
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Abreu A, Pesah E, Supervia M, Turk-Adawi K, Bjarnason-Wehrens B, Lopez-Jimenez F, Ambrosetti M, Andersen K, Giga V, Vulic D, Vataman E, Gaita D, Cliff J, Kouidi E, Yagci I, Simon A, Hautala A, Tamuleviciute-Prasciene E, Kemps H, Eysymontt Z, Farsky S, Hayward J, Prescott E, Dawkes S, Pavy B, Kiessling A, Sovova E, Grace SL. Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries? Eur J Prev Cardiol 2019; 26:1131-1146. [DOI: 10.1177/2047487319827453] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Ana Abreu
- Cardiology Department, Hospital Santa Maria, Portugal
| | - Ella Pesah
- Department of Kinesiology and Health Sciences, York University, Canada
| | - Marta Supervia
- Physical Medicine and Rehabilitation, Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Spain
| | | | | | | | - Marco Ambrosetti
- Istituti Clinici Scientifici Maugeri, Care and Research Institute Department of Cardiac Rehabilitation, Italy
| | - Karl Andersen
- Department of Internal Medicine, University of Iceland, Iceland
| | - Vojislav Giga
- Institute of Cardiovascular Diseases, Clinical Center of Serbia, Serbia
| | - Dusko Vulic
- University of Banja Luka, Center for Medical Research, Bosnia and Herzegovina
| | - Eleonora Vataman
- Institute of Cardiology, Moldova Academy of Science, Republica Moldova
| | - Dan Gaita
- University of Medicine and Pharmacy “Victor Babes”, Cardiovascular Prevention and Rehabilitation Clinic, Romania
| | - Jacqueline Cliff
- Cardiac Rehabilitation Department, Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, UK
| | - Evangelia Kouidi
- Department of First Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - Ilker Yagci
- Physical Medicine and Rehabilitation Department, Marmara University School of Medicine, Turkey
| | - Attila Simon
- Cardiac Rehabilitation Department, State Hospital for Cardiology, Hungary
| | - Arto Hautala
- Cardiovascular Research Group, Oulu University Hospital, Finland
| | | | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, The Netherlands
| | - Zbigniew Eysymontt
- Cardiac Rehabilitation Department, Ślaskie Centrum Rehabilitacji w Ustroniu, Poland
| | | | - Jo Hayward
- Cardiology Department, Norfolk and Norwich University Hospital, UK
| | - Eva Prescott
- Cardiology Department, Bispebjerg Frederiksberg Hospital, Denmark
| | - Susan Dawkes
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Bruno Pavy
- Cardiac Rehabilitation Department, Loire-Vendée-Océan Hospital, France
| | - Anna Kiessling
- Karolinska Institutet, Department of Clinical Sciences Danderyd Hospital, Sweden
| | - Eliska Sovova
- Department of Internal Medicine, University of Palacky, University Hospital Olomouc, Czech Republic
| | - Sherry L Grace
- Department of Kinesiology and Health Sciences, York University, Canada
- Toronto Rehabiliation Institute, University Health Network, Canada
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Egholm CL, Helmark C, Doherty P, Nilsen P, Zwisler AD, Bunkenborg G. "Struggling with practices" - a qualitative study of factors influencing the implementation of clinical quality registries for cardiac rehabilitation in England and Denmark. BMC Health Serv Res 2019; 19:102. [PMID: 30728028 PMCID: PMC6366013 DOI: 10.1186/s12913-019-3940-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 01/30/2019] [Indexed: 12/14/2022] Open
Abstract
Background The use of clinical quality registries as means for data driven improvement in healthcare seem promising. However, their use has been shown to be challenged by a number of aspects, and we suggest some may be related to poor implementation. There is a paucity of literature regarding barriers and facilitators for registry implementation, in particular aspects related to data collection and entry. We aimed to illuminate this by exploring how staff perceive the implementation process related to the registries within the field of cardiac rehabilitation in England and Denmark. Methods A qualitative, interview-based study with staff involved in collecting and/or entering data into the two case registries (England N = 12, Denmark N = 12). Interviews were analysed using content analysis. The Consolidated Framework for Implementation Research was used to guide interviews and the interpretation of results. Results The analysis identified both similarities and differences within and between the studied registries, and resulted in clarification of staffs´ experiences in an overarching theme: ´Struggling with practices´ and five categories; the data entry process, registry quality, resources and management support, quality improvement and the wider healthcare context. Overall, implementation received little focused attention. There was a lack of active support from management, and staff may experience a struggle of fitting use of a registry into a busy and complex everyday practice. Conclusion The study highlights factors that may be important to consider when planning and implementing a new clinical quality registry within the field of cardiac rehabilitation, and is possibly transferrable to other fields. The results may thus be useful for policy makers, administrators and managers within the field and beyond. Targeting barriers and utilizing knowledge of facilitating factors is vital in order to improve the process of registry implementation, hence helping to achieve the intended improvement of care processes and outcomes. Electronic supplementary material The online version of this article (10.1186/s12913-019-3940-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cecilie Lindström Egholm
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Southern Region of Denmark, Vestergade 17, 5800, Nyborg, Denmark. .,Department of Medicine, Holbaek University Hospital, Smedelundsgade 60, 4300, Holbaek, Region Zealand, Denmark.
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, 4000, Roskilde, Denmark
| | - Patrick Doherty
- The National Audit of Cardiac Rehabilitation, Department of Health Sciences, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD, UK
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Campus US, Hus 511-001, ingång 76, plan 13, 58183, Linköping, Sweden
| | - Ann-Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Southern Region of Denmark, Vestergade 17, 5800, Nyborg, Denmark
| | - Gitte Bunkenborg
- Department of Anaestesiology, Holbaek University Hospital, Smedelundsgade 60, 4300, Holbaek, Region Zealand, Denmark
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Noori T, Ghazisaeedi M, Aliabad GM, Mehdipour Y, Mehraeen E, Conte R, Safdari R. International Comparison of Thalassemia Registries: Challenges and Opportunities. Acta Inform Med 2019; 27:58-63. [PMID: 31213746 PMCID: PMC6511274 DOI: 10.5455/aim.2019.27.58-63] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Patient registries use standardized methods to systematically gather uniform data for specific groups of patients managed in clinical practice to evaluate specified outcomes. Aim: The objective of this study was to identify and describe structures of the identified thalassemia registries in worldwide and summarize their key characteristics. Methods: We reviewed the literature on thalassemia registries. A search of PubMed, Scopus, ProQuest, and Science Direct databases was conducted in September 2018. We also reviewed the existing thalassemia registry websites in different countries. The keywords used to our search were as follows: Thalassemia, Hemoglobinopathy, Registry, Database, and Registration System. Some features such as the name of registry, funding source, objectives of the registry, minimum data set, and methods of data collection were determined. Results: We identified 16 thalassemia registries operating on a multinational, national, or regional level between1984 and 2016. Most of these aimed to improve the diagnosis and management of control programs. Government funding was the most common funding source for registries. Furthermore, the most common method of data submission was Web-based data entry. The data were entered by a member of the clinical team or a nominated data manager. Conclusion: Registries provide a positive return on investment; their establishment and maintenance require ongoing support by government, policy makers, research funding bodies, clinicians, thalassemia patients and their caregivers. However, the results of research suggest the establishment of an international network for coordination and collaboration between thalassemia registries.
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Affiliation(s)
- Tayebeh Noori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeedi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Miri Aliabad
- Children and Adolescent Health Research Center, Department of Pediatric Hematology-Oncology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Yousef Mehdipour
- Department of Health Information Technology, School of Allied Medical Sciences, Zahedan University of Medical Sciences, Zahedan
| | - Esmaeil Mehraeen
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Rosa Conte
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Zecchin R, Candelaria D, Ferry C, Ladak LA, McIvor D, Wilcox K, Bennett A, Bowen S, Carr B, Randall S, Gallagher R. Development of Quality Indicators for Cardiac Rehabilitation in Australia: A Modified Delphi Method and Pilot Test. Heart Lung Circ 2018; 28:1622-1630. [PMID: 30220480 DOI: 10.1016/j.hlc.2018.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/01/2018] [Accepted: 08/20/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND International guidelines recommend cardiac rehabilitation (CR) for secondary prevention of cardiovascular disease, however, it is underutilised and the quality of content and delivery varies widely. Quality indicators (QIs) for CR are used internationally to measure clinical practice performance, but are lacking in the Australian context. This study reports the development of QIs for minimum dataset (MDS) for CR and the results of a pilot test for feasibility and applicability in clinical practice in Australia. METHODS A modified Delphi method was used to develop initial QIs which involved a consensus approach through a series of face-to-face and teleconference meetings of an expert multidisciplinary panel (n=8), supplemented by an environmental scan of the literature and a multi-site pilot test. RESULTS Eight (8) QIs were proposed and sent to CR clinicians (n=250) electronically to rate importance, current data collection status, and feasibility of future collection. The top six of these QIs were selected with an additional two key performance indicators from the New South Wales (NSW) Ministry of Health and two QIs from international registers for a draft MDS. The pilot test in 16 sites (938 patient cases) demonstrated median performance of 93% (IQR 47.1-100%). All 10 QIs were retained and one further QI related to diabetes was added for a final draft MDS. CONCLUSIONS The MDS of 11 QIs for CR provides an important foundation for collection of data to promote the quality of CR nationally and the opportunity to participate in international benchmarking.
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Affiliation(s)
- Robert Zecchin
- Western Sydney Local Health District (LHD), Sydney, NSW, Australia; Australian Cardiovascular Health and Rehabilitation Association (ACRA), NSW, Australia
| | - Dion Candelaria
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Cate Ferry
- National Heart Foundation of Australia (New South Wales Division), Sydney, NSW, Australia; Australian Cardiovascular Health and Rehabilitation Association (ACRA), NSW, Australia
| | - Laila Akbar Ladak
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Dawn McIvor
- Hunter New England LHD, Newcastle, NSW, Australia; Australian Cardiovascular Health and Rehabilitation Association (ACRA), NSW, Australia
| | - Kerry Wilcox
- Northern NSW LHD, Lismore, NSW, Australia; Australian Cardiovascular Health and Rehabilitation Association (ACRA), NSW, Australia
| | | | - Sheryl Bowen
- Mid North Coast LHD, Coffs Harbour, NSW, Australia; Australian Cardiovascular Health and Rehabilitation Association (ACRA), NSW, Australia
| | - Bridie Carr
- Agency for Clinical Innovation (ACI) NSW, Sydney, NSW, Australia
| | - Sue Randall
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Robyn Gallagher
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; Australian Cardiovascular Health and Rehabilitation Association (ACRA), NSW, Australia.
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Lindström Egholm C, Rossau HK, Nilsen P, Bunkenborg G, Rod MH, Doherty P, Bartels P, Helmark L, Zwisler AD. Implementation of a politically initiated national clinical guideline for cardiac rehabilitation in hospitals and municipalities in Denmark. Health Policy 2018; 122:1043-1051. [PMID: 30093082 DOI: 10.1016/j.healthpol.2018.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 11/18/2022]
Abstract
A politically initiated national clinical guideline was launched in Denmark in 2013 to improve quality and equality of cardiac rehabilitation (CR) services. The guideline is to be implemented in both hospital and community (municipality) settings due to shared responsibility for provision of CR services. Little is known about implementation outcomes of a guideline in these two settings. We aimed to study this by determining the extent to which Danish CR services in hospitals and municipalities adhered to national recommendations following the launch of the guideline. The study employed an observational, longitudinal design. Data were gathered by a questionnaire survey to compare CR services at baseline, measured in 2013 immediately before the guideline was launched, with CR services at a two-year follow up in 2015. All Danish hospital departments offering CR services (N = 36) and all municipalities (N = 98) were included. Data were analysed using inferential statistics. Hospitals reported improvement of both content and quality of CR services. Municipalities reported no change in content of services, and lower level of fulfilment of one quality aspect. The results suggest that the guideline had different impact in hospitals and municipalities and that the differences in content and quality of services between the two settings increased in the study period, thus contradicting the guideline´s aim of uniform, evidence-based content of CR services across settings.
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Affiliation(s)
- Cecilie Lindström Egholm
- Department of Medicine, Holbæk University Hospital, Region Zealand, Holbæk, Denmark; Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark.
| | - Henriette Knold Rossau
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Gitte Bunkenborg
- Department of Anesthesiology, Holbæk University Hospital, Region Zealand, Holbæk, Denmark
| | - Morten Hulvej Rod
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, North Yorkshire, United Kingdom
| | | | - Lotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Ann-Dorthe Zwisler
- Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Odense, Denmark
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Li S, Fonarow GC, Mukamal K, Xu H, Matsouaka RA, Devore AD, Bhatt DL. Sex and Racial Disparities in Cardiac Rehabilitation Referral at Hospital Discharge and Gaps in Long-Term Mortality. J Am Heart Assoc 2018; 7:JAHA.117.008088. [PMID: 29626153 PMCID: PMC6015394 DOI: 10.1161/jaha.117.008088] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Cardiac rehabilitation (CR) referral is recommended for eligible patients, regardless of sex or race. It is unclear whether inequality in CR referral practices was associated with patients’ long‐term survival. Methods and Results We linked the American Heart Association Get With The Guidelines Coronary Artery Disease registry with Medicare claims data for 48 993 coronary artery disease patients from 365 hospitals across the United States between 2003 and 2009. We used generalized estimation equations to estimate the association between CR referral and mortality accounting for clustering within hospitals. Between 2003 and 2009, only 40% of eligible patients received CR referrals. Females were 12% less likely to receive CR referral compared with males. Black, Hispanic, and Asian patients were 20%, 36%, and 50% less likely, respectively, to receive CR referral than white patients. CR referral was associated with 40% lower 3‐year all‐cause mortality. Women and minorities who received CR referral at hospital discharge had significantly lower mortality compared with those who did not (odds ratios=0.61 [95% confidence interval, 0.56–0.66] for women, 0.75 [95% confidence interval, 0.63–0.88] for black, 0.62 [95% confidence interval, 0.50–0.79] for Hispanic, and 0.63 [95% confidence interval, 0.46–0.85] for Asian patients). Seven percent of the black versus white mortality gap could potentially be reduced by equitable CR referral. Conclusions CR referral rates at hospital discharge remained low. Gaps in receiving CR referral at hospital discharge were large for women and minorities, and the mortality gap could potentially be reduced through elimination of inequality in CR referral.
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Affiliation(s)
- Shanshan Li
- Boston University School of Medicine, Boston, MA
| | | | | | - Haolin Xu
- Duke Clinical Research Institute, Durham, NC
| | - Roland A Matsouaka
- Duke Clinical Research Institute, Durham, NC.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | | | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA
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Sérvio TC, Ghisi GLDM, Silva LPD, Silva LDN, Lima MMO, Pereira DAG, Grace SL, Britto RR. Availability and characteristics of cardiac rehabilitation programs in one Brazilian state: a cross-sectional study. Braz J Phys Ther 2018; 22:400-407. [PMID: 29622521 DOI: 10.1016/j.bjpt.2018.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/28/2018] [Accepted: 03/12/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cardiac rehabilitation (CR) is a recommended model of care for cardiovascular diseases; however, is not widely available and is underutilized, especially in low- and middle-income countries. OBJECTIVES To identify the CR programs available in one Brazilian state (Minas Gerais; MG) and describe their characteristics by funding type. METHODS In this multi-center descriptive study, CR programs were identified in four MG regions and 41 CR coordinators were sent a survey to report the characteristics of their programs, including CR components described in guidelines and barriers to patients' participation. Descriptive and comparative analysis between public and private programs were carried out. RESULTS Forty-one CR programs were identified, only 21.9% public. Nineteen completed the survey. The majority of CR programs offered initial assessment and physical training. Components of comprehensive CR programs that were rarely offered included treatment of tobacco dependence, psychological support and lipid control. Physical therapists were present in all CR programs. The six-minute walk test was used in most programs to assess functional capacity. Programs were located intra-hospital only in public hospitals. Phase 2 (initial outpatient) and phase 4 (maintenance) were offered significantly more in private programs when compared to public ones. The main barrier for CR participation was the lack of referral. CONCLUSIONS The availability of CR programs in MG state is low, especially public programs. Most programs do not offer all core components of CR.
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Affiliation(s)
| | - Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Lilian Pinto da Silva
- Universidade Federal de Juiz de Fora (UFJF), Faculdade de Fisioterapia, Juiz de Fora, MG, Brazil
| | - Luciana Duarte Novais Silva
- Universidade Federal do Triângulo Mineiro (UFTM), Departamento de Fisioterapia Aplicada, Uberaba, MG, Brazil
| | - Marcia Maria Oliveira Lima
- Universidade Federal do Vale do Jequitinhonha e Mucuri (UFVJM), Departamento de Fisioterapia, Diamantina, MG, Brazil
| | | | - Sherry L Grace
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada; School of Kinesiology and Health Science, Toronto, Canada
| | - Raquel Rodrigues Britto
- Universidade Federal de Minas Gerais (UFMG), Departamento de Fisioterapia, Belo Horizonte, MG, Brazil.
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Piepoli MF. Editor’s presentation. Eur J Prev Cardiol 2017; 24:1571-1574. [DOI: 10.1177/2047487317736953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit Cardiology, G da Saliceto Hospital, Piacenza, Italy
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